Member Services Representative Medical Salary in Gallatin, Tennessee

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Average Salary for Member Services Representative Medical in Gallatin, Tennessee

The average salary of a(n) Member Services Representative Medical in Gallatin, Tennessee is $38,321.

The average hourly rate of a(n) Member Services Representative Medical in Gallatin, Tennessee is $18.42.

The average bonus of a(n) Member Services Representative Medical in Gallatin, Tennessee is $778.00.

Job Description:

Communicates effectively with providers and members of the health plan, answering inquiries about member eligibility, plan benefits, claims status, and demographics. Provides customer service in a senior capacity to plan members, providers, and employer groups by answering complex benefit questions, resolving issues, and educating callers. Serves as a resource for all entry-level Member Service Representatives and may assist with resolution of issues or handle calls that cannot be resolved by less experienced staff. Typically has more than three years of experience in customer service. Receives inquiries from members via the Internet, telephone, and in writing regarding covered benefits. Provides assistance in resolving problems such as finding physicians, arranging transportation, ordering identification cards, changing primary care case managers, filing appeals, resolving billing errors, and accessing payment. Maintains records of all contacts and results. Provides claim status, payment amounts, and/or denials for processed claims. Assists providers with standard electronic claims submission questions and works with providers to resolve problems in filing electronic claims. Researches and resolves problems, complaints and concerns. Mails out provider directories and new member packets. Assists providers and members in accessing information via the organization's online services directory. Reports suspected cases of member of provider fraud and abuse. Reports successive claims payment issues or member issues to management for appropriate intervention. May intercede on the member's behalf with providers and other parties to resolve member problems. Less

Communicates effectively with providers and members of the health plan, answering inquiries about member eligibility, plan benefits, claims status, and demographics. Provides customer service in a senior capacity to plan members, providers, and employer groups by answering complex benefit questions,... More

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