Member Services Representative

ASR Health Benefits is a third-party administrator of health plans, including medical, dental, vision, short-term disability, Section 125, and consumer-directed health plans.  We administer these health plans through dedicated client service teams, consisting of staff members from each department at ASR who work together to meet our clients’ needs.

ASR is currently seeking an MSR to join our team. We offer a dynamic work environment with opportunities for professional growth and development. At ASR, we follow a remote work structure, and/or from the office based on specific tasks or personal work preferences.

Position Overview:

The Member Services Representative (MSR) is responsible for providing specialized call management, advocacy, and education to members, ensuring excellent customer service in alignment with company mission and values. The MSR serves as the point person for member inquiries, issues, and concerns, guiding them through their claims and assisting with timely resolutions. This role requires strong communication skills, critical thinking, and the ability to work collaboratively within the claims unit to foster positive member experiences.

Key Responsibilities:

• Case Management & Advocacy: Manage assigned member caseload using a high-touch advocacy model to enhance the member experience and encourage engagement.
• Customer Service: Providing quality customer service while assisting members on the phone with benefit questions and claim status.
• Claims Assistance: Apply independent judgment and problem-solving skills to assist members with their claim inquiries, ensuring positive outcomes.
• Issue Resolution: Act as the primary point of contact for escalated member issues, ensuring timely resolution through coordination with internal and external parties.
• Cross-functional Coordination: Facilitate communication among members, internal staff, and providers as needed, escalating issues to supervisors or legal when necessary.
• Documentation & Tracking: Maintain accurate and detailed records of member inquiries and resolutions using WebCSR software. Document all stages of the process and ensure timely follow-ups.
• Collaboration: Work closely with internal departments to address service issues and identify opportunities for process and systemic improvements.
• Claims Processing: Assist in claims processing as needed, including validating medical, dental, vision, flex, and HRA claims. Apply knowledge of HIPAA regulations when handling sensitive information.
• Problem Solving & Compliance: Identify and resolve claim issues, including duplicate claims, late charges, and incorrect billing, while adhering to HIPAA guidelines.
• Data Entry & Proofreading: Ensure all claims information is complete and accurate; proofread manually entered claims.
• Goal Achievement: Meet daily production and performance goals while maintaining a high level of accuracy and quality in all tasks.
• Other Assignments: Perform additional duties as assigned by management.

Qualifications:

• Education: High School Diploma or GED required; Bachelor’s degree preferred.
• Experience: Minimum of two years in a claims processing, data entry, or customer service role within a TPA, insurance company, or healthcare environment.
• Skills:
• Strong verbal and written communication skills.
• Proficiency in Microsoft Outlook, Word, Excel, and internet navigation.
• Ability to multi-task in a fast-paced, deadline-driven environment.
• Experience in billing, insurance, healthcare, or legal environments is a plus.
• Familiarity with UB-04 and CMS-1500 billing forms is a plus.
• Knowledge:
• Strong understanding of HIPAA regulations.
• Knowledge of claims processing and healthcare claims systems.
• Attributes:
• Ability to work independently with limited supervision.
• Strong problem-solving skills and critical thinking.
• High attention to detail and ability to manage competing priorities.
• Demonstrated success in client-focused solutions.

Please visit www.asrhealthbenefits.com and navigate to the CAREERS link on the homepage to view ASR's current openings.  

ASR is an equal opportunity employer committed to creating an inclusive environment for all employees.

No agencies please.