Customer Care Specialist - Commercial & Medicare Advantage

Customer Care Specialist - Commercial & Medicare Advantage - (2300606) The Customer Care Specialist-Commercial & Medicare Advantage position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, OH or Rossford, OH Medical Mutual offices.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio.
We provide peace of mind to more than 1.
6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans.
We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.
Medical Mutual’ s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors.
Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.
Responds to and resolves a variety of member and provider (Commercial) inquiries regarding the Company's health insurance products and services primarily in the commercial line, and secondarily in the Medicare Advantage (MA) line (especially during open enrollment peak periods-October through March).
Balances workload and achieves maximum efficiency to ensure timely, complete and accurate resolution is provided to customers on first contact.
Navigates systems and confidently provides outstanding customer service in accordance with established quality expectations and service philosophy.
Works to build customer loyalty by ensuring customer needs are met.
Responsibilities · Responds to a variety of member and provider inquiries from commercial and Medicare Advantage product lines through determined channels such as telephone, written, email, and face-to-face.
Communicates information/solutions clearly, accurately, and effectively in a manner that provides peace of mind to the customer.
For MA, identifies and documents complaints and appeals to in accordance with Center for Medicare/Medicaid Services (CMS) regulations.
· Conducts research and takes appropriate action on customer inquiries specific to determined channel(s).
Recognizes and takes action to address issues that may impact other customers.
(Strives for resolution on first contact).
· Builds and maintains commercial and Medicare Advantage knowledge and skills.
Participates in refresher or other training as needed.
· Determines conditions to apply system overrides and accurately determines manual calculations for commercial claims/adjustments.
· Performs other duties as assigned.
Qualifications Education and Experience: · Bachelors' Degree in Business Administration, Communications or related field is preferred, but will consider collective experience, training, and education.
· Minimum 1 year as an (Associate)/Customer Care Specialist (CCS) which includes successful completion of internal training program and demonstrated ability to consistently meet/exceed core performance metrics.
· Successful completion of internal commercial and Medicare Advantage training program which consists of classroom and on the job training.
Technical Skills and Knowledge: · Intermediate Microsoft Office and contact center and claims systems skills.
· Knowledge of the Company's commercial and Medicare product offerings, systems and operational policies and procedures.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees.
That's why we offer an exceptional package that includes: A Great Place to Work: Top Workplace in Northeast Ohio.
Year after year we've received this recognition! On-site wellness center at most locations.
Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes! On-site cafeteria serving hot breakfast and lunch, at most locations.
Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily.
Convenience store at most locations Employee discount program.
Discounts at many places in and around town, just for being a Medical Mutual team member Business Casual attire Excellent Benefits and Compensation: Competitive compensation plans Employee bonus program 401(k) with company match and an additional company contribution Excellent medical, dental, vision, and disability insurance An Investment in You: Career development programs and classes Mentoring and coaching to help you advance Education reimbursement up to $5K per year About Medical Mutual: We strive to create peace of mind.
Our customers can trust us to do things right and to help them get value from their health plan.
We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work.
Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance.
We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state.
Join us at one near you! At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community.
We are proud to be an Equal Employment Opportunity and Affirmative Action Employer.
Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
Primary Location US-OH-Rossford Other Locations US-OH-Brooklyn Job 7 - General Staff Organization Customer Care Schedule Regular Shift Standard Employee Status Individual Contributor Job Type Full-time Job Level Day Job Job Posting Nov 21, 2023, 12:12:14 PM