Job Highlights
Using AI ⚡ to summarize the original job post
McLaren Integrated HMO Group (MIG) is seeking a Customer Service Representative to join their team. This role involves handling member telephone calls, directing members to the proper services, educating them, problem-solving, and creating linkages to the Medical Management Department for authorization of services. The position is remote and offers the opportunity to be part of a dynamic organization dedicated to improving health care services.
Responsibilities
- Handle daily member telephone calls
- Direct members to the proper services needed
- Educate members
- Problem solve for members
- Create linkages to the Medical Management Department for authorization of services
- Assist providers with eligibility, benefit, and resolution of claims issues
Qualifications
Required
- High School Diploma or equivalent certification
- One (1) year experience in a customer service related role with direct contact with customers via telephone, email, chat and/or face-to-face
Preferred
- One (1) year experience in a physician health care office environment or high-volume call center
- One (1) year experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions
About McLaren Health Care
McLaren Health Care is a reputable healthcare organization based in Michigan, United States, operating 13 hospitals, outpatient clinics, and other healthcare facilities. It offers a wide range of healthcare services including cardiology, oncology, orthopedics, neurology, and critical care with a focus on patient safety and quality outcomes. McLaren Health Care is known for its excellent care, patient satisfaction, and strategic investments to enhance services and collaborations within the region.
Full Job Description
We are looking for a Customer Service Representative to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.
As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based
health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at
https://www.mclarenhealthplan.org
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at
https://www.mdwise.org/
.
**Position Summary:**
This position will be responsible for daily member telephone calls which will include directing members to the proper services needed, educating members, problem solving, and creating linkages to the Medical Management Department for authorization of services. Also may be responsible for assisting providers with eligibility, benefit, and resolution of claims issues.
**Equal Opportunity Employer of Minorities/Females/Disabled/Veterans**
+ **Qualifications:** _Required:_
+ High School Diploma or equivalent certification;
+ One (1) year experience in a customer service related rolewith direct contact with customers via telephone, email, chat and/or face-to-face. _Preferred:_
+ One (1) year experience in a physician health care office environment or high-volume call center.
+ One (1) yearexperience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions.