Why MediGold?
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.
Position Purpose:
The Member Service Representative responds to all consumer inquiries received by phone, in person or in writing regarding product plan benefits, services, organizational determinations, reconsiderations, complaints and general inquiries in accordance with the rules and regulations of a Medicare Advantage plan and governing agencies. Implements retention strategies to maintain current membership and improve the quality of care and service.
What you'll do:
Exhibits each of the Mount Carmel Service Excellence Behavior Standards holding self and others accountable and role modeling excellence for all to see. For example: demonstrates friendliness and courtesy, effective communication creates a professional environment and provides first class service.Meets population specific and all other competencies according to department requirements.Promotes a Culture of Safety by adhering to policy, procedures and plans that are in place to prevent workplace injury, violence or adverse outcome to associates and patients.Relationship-based Care: Creates a caring and healing environment that keeps the patient and family at the center of care throughout their experience at Mount Carmel following the principles of our interdisciplinary care delivery system.Complies with internal policies, Center for Medicare and Medicaid Services (CMS), Ohio Department of Insurance (ODI), NCQA and all applicable Federal regulations.Develop a thorough understanding of the applicable rules and audit protocols that govern all aspects consumer service activities and demonstrated ability to pass audits of activities.Engages with consumers to effectively meet or exceed individual and team service performance goals in a manner that is compliant with all Federal, State and governing requirements.Receive, interpret and accurately respond to consumer inquiries, both verbally and in writing in ways that reflect a positive, compassionate and affirming manner while ensuring compliance with Federal regulations.To discern the needs of consumers with commitment to providing the highest level of service possible with measurable outcomes. Utilize interpreting services and accurately provide answers to consumers via foreign language interpreters to assist limited English speaking consumers.Achieve and maintain a superior (5-STAR) CMS rating in member/consumer satisfaction.Consistently document and accurately code all inquiries within designated software to reflect the purpose of a consumer's inquiry and all actions taken to address and resolve their issue or need.Generate standard or customized letters and reports to accurately respond to inquiries as needed.To obtain and maintain a thorough knowledge of plan benefits, services, understanding of Federal rules and requirements and be able to communicate such knowledge to consumers effectively.What we're looking for:
Education: Minimum of high school education with some college level studies preferredExperience: Customer Service along with knowledge of governmental agencies and regulations, especially Medicare and the Centers for Medicare and Medicaid Services (CMS) desired.Effective Communication Skills; consumer retention and strategic thinking.Demonstrated knowledge and effective organizing multi-tasks, in a high volume, fast-paced team environment.Knowledge of managed care benefit plans and products.PC proficient including word-processing, data entry, Microsoft office and various software.Medical terminology and medical claims processing a plus.Position Highlights and Benefits:
Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.Retirement savings account with employer match starting on day one.Generous paid time off programs.Employee recognition programs.Tuition/professional development reimbursement.Relocation assistance (geographic and position restrictions apply).Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.Employee Referral Rewards program.Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.Ministry/Facility Information:
Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our four hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.