What you will get to do:
This entry-level position is responsible for managing all inquiries from active, terminated, and prospective members of Medica. The Health Plan Specialist II is a primary contact for members to resolve service problems for claims, enrollment, billing, pharmacy as well as interpreting contracts and explaining benefits. They are responsible for exceptional levels of service satisfaction, providing quality service, and the service recovery process. The service recovery process is critical to the success of the department. The Health Plan Specialist II will use this process to assist members in complex situations.
The degree of client satisfaction and retention Medica achieves with membership is directly related to the success of the customer service teams. The Health Plan Specialist II is responsible for identifying, researching and resolving member and all other internal and external customer concerns, problems and issues in a timely and courteous manner. Health Plan Specialist II’s are expected to work with enrollment, billing and other departments within Medica to resolve member issues.
The Health Plan Specialist II’s typically interact with a number of external and internal customers. External customers include the following: active, terminated, and prospective customers (providers and third-party administrators). Internal customers include: employees in medical management, enrollment, billing, claims, sales/marketing and legal. Outside vendors may include: pharmacy benefits managers, behavioral health and dental providers.
Advancement opportunities are moderate to high. After mastering the claims, pharmacy and benefits skill sets within this position and performing at above standard levels, the Health Plan Specialist II could move into higher Health Plan Specialist tiers. From there, the Health Plan Specialist could move into a Lead, Issue Resolution Analyst, Client Specialist, Quality Administrator, Consumer Affairs Advisor or supervisory position within the department or other Medica departments. Manager positions may be available in Customer Service, Provider Service Center, Special Investigations Unit, Claims Analysis and Recovery, Electronic Commerce and Project Management. A technical route may include IT Service Desk, Business Analyst and Electronic Commerce Specialist positions.
1-2 years customer service experience required
Associate’s degree or equivalent work experience required. Bachelor’s degree preferred
Excellent verbal and written communication skills
The Customer Service department’s leadership is very focused toward the common goal of delivering high quality service to Medica’s members. The department encourages team interaction and support of each other in dealing with customer issues.
Advanced ability to multi task and manage time efficiently is needed.
An ability to identify process improvements, provide mentor and peer feedback and develop knowledge of multiple products and platforms is required.
Demonstrated ability to learn quickly and respond well to a rapidly changing industry and operational environment.
Hours: Mon-Fri – 7am-8pm AND Sat – 9am-3pm
Equal Opportunity Employer Including Veterans and Disabled Individuals
At Medica, you'll enjoy working with talented people who share a mission to meet our customers' needs.
Medica will support you through your personal growth and involvement in the community.
Medica provides resources that allow you to take charge of your health and career.