UFCW & Employers Trust LLC Hiring for Healthcare Call Center Representative Job at Roseville, CA Full Time

At UFCW & Employers Trust, every one of our staff is committed to providing efficient, responsive, friendly service and accurate information to serve all of our constituencies: our employee members, dependents, local unions, employers and service providers.

If you are looking for an excellent opportunity in a great work environment, first class benefits, and opportunities to grow professionally, UFCW & Employers Trust wants to hear from you!

At UFCW & Employers Trust, we are currently seeking a Health & Welfare Services Representative to join our team in Roseville! We are hiring for on-site permanent positions during COVID-19!

We Offer:

• A great work environment! Our employees’ average tenure is over 10 years. We are friendly, passionate, hard-working and fun!
• $25.57 an hour with scheduled yearly increases
• First class benefits (medical, dental, vision) with no premiums for employees and low premiums for dependents
• Generous Vacation and Sick Time
• Generous holidays (92 hours per year)
• Pension Plan
• Complimentary coffee service everyday
• Fun events
• Free parking
• COVID safety measures (masks, hand sanitizer, disinfecting supplies, enhanced cleaning measures, social distancing, etc.)
• A variety of paths for career advancement and opportunities to grow professionally

JOB SUMMARY

The Member Service Representative must apply an in-depth knowledge of all welfare plans including eligibility rules and covered benefits, in addition to a general knowledge of medical, sick leave, retiree coverage, vision care, and prescription drug administrative processes. The Member Service Representative assists members with all aspects of the Plans’ health and welfare benefits and resolves a broad range of questions and problems received from members, beneficiaries, union locals, service providers and other departments of the Fund office.

Essential Duties and Responsibilities:

• Performs various duties and responsibilities of Member Services Assistant and Member Services Assistant Lead.
• Communicates via telephone, in person and written correspondence, answers questions from members, beneficiaries, union locals, providers and other Fund office departments regarding the Plans’ benefits, eligibility, claims processing and claims appeals.
• Obtains all pertinent information to determine specific purpose of call and/or walk-in.
• Writes an eligibility appeal, sick leave and/or basic medical appeal if necessary.
• Initiates and prepares correspondence and other documentation to resolve questions and provide information to members and others in accordance with Plans’ rules, regulations, and practices.
• Initiates and reviews various applications, notices, forms, certifications, self-payments, COBRA, stop payments, clear claim notices.
• Identifies and corrects information on Computer system and /or refers to appropriate staff for correction.
• Determines eligibility in accordance with Plan rules and resolves eligibility issues and questions. Confirms or denies coverage based on eligibility rules of the members plan.
• Maintains appropriate documentation of all calls & walk-ins. Handles walk-ins in a courteous and professional manner. Discerns needs and verifies forms from a walk-in and refers to appropriate personnel based on walk-ins needs.
• Acts as liaison between member and provider to communicate Plan benefits and facilitate claims processing.
• Calculates sick leave banks.
• Refers calls, members, union locals and others to appropriate department.
• Assists with special projects as requested.

Qualifications:

• High school diploma.
• Extensive communication skills and knowledge of grammar, spelling and simple mathematical functions like percentages, ratios, etc.
• Requires knowledge of medical terminology and procedures.
• 1 year prior Medical Customer service experience.
• Strong analytical and organizational skills.
• Bilingual experience a plus.

Work Environment:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is regularly required to sit and use hands to handle or feel objects, tools or controls. The employee frequently is required to talk or hear. The employee is occasionally required to stand, walk, and reach with hands and arms.
• The employee must regularly lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.
• The noise level in the work environment is usually moderate.

Note: This position is subject to a pre-employment negative drug screen and satisfactory completion of a background check and reference checks.