Top 825 Member services representative Jobs in Louisville, Ky

Health Plan Member Services Analyst
Abilis Health Plan —Louisville, KY
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Health insurance
- Prescription drug insurance
Customer Service Representative
IMI Plc - Legacy Precision —Louisville, KY
- $26 - $29 an hour
- Full-time
- Hybrid work
- Microsoft Outlook
- Office
- High school diploma or GED
- Health savings account
- Employee stock purchase plan
2d
Part-Time Member Service Representative/Teller- Louisville, KY
L&N Federal Credit Union —Louisville, KY
- Part-time
- High school diploma or GED
- Financial services
- Typing
Quick Apply
iPay Call Center Representative (CCC)
Jack Henry —Louisville, KY
- $34,320 - $37,500 a year
- 8 hour shift
- Remote
- Research
- In-person
- 1 year
- Work from home
Therapist / Social Worker- Deaf and Hard of Hearing
Seven Counties Services —Louisville, KY
- Full-time
- LMFT
- Customer service
- Licensed Clinical Social Worker
Clinical Pharmacist
Nutrishare —Louisville, KY
- $135,000 - $153,000 a year
- Overtime
- Doctoral degree
- Basic math
- English
- Health savings account
- Health insurance
Quick Apply
Service Maintenance Technician
Bethlehem Die Cutting a Division of Kyana Packaging Solutions —New Albany, IN
- From $25 an hour
- Urgently hiring
- Background check
- Clean driving record
- Basic math
- Health savings account
- Health insurance
Quick Apply
Hyper Wellness Representative
Restore Hyper Wellness Louisville —Louisville, KY
- $15 - $17 an hour
- Part-time
- In-person
- Teaching
- Entry level
- Employee discount
- Flexible schedule
Quick Apply
Registered Dietitian / Nutritionist - Full Time $10K SignOn-Kindred Hospital at Jewish Hospital
Kindred Hospitals —Louisville, KY
- $62,000 - $87,000 a year
- Full-time
- Background check
- Word processing
- Inpatient
- Health insurance
- Dental insurance
Quick Apply
8d
Clinical Pharmacist- Per Diem
Nutrishare —Louisville, KY
- $63 - $70 an hour
- Overtime
- Doctoral degree
- Basic math
- English
- Opportunities for advancement
Quick Apply
Executive Director
River Hills Economic Development District & Regional Planning Commission —Jeffersonville, IN
- $85,000 - $115,000 a year
- Email
- Background check
- 5 years
- Research
Quick Apply
14d
Wealth Management Trainee (KY)
Bankers Life —Louisville, KY
- $50,000 - $80,000 a year
- Full-time
- Customer service
- No experience needed
- Entry level
Quick Apply
Sales Representative
Southern Roofing and Renovations —Jeffersontown, KY
- From $100,000 a year
- Extended hours
- Clean driving record
- Ability to walk for extended periods
- Residential
- Health savings account
- Health insurance
Quick Apply
Hotel Valet Attendant - Hotel Distil and Moxy Louisville
Towne Park —Louisville, KY
- $10 - $11 an hour
- Part-time
- Writing skills
- Basic math
- English
- 401(k)
Car Hauler Mechanic
Precision Vehicle Holdings —Louisville, KY
- $35.03 an hour
- Pass drug screening
- Mid-level
- Driver's License
Quick Apply
Registered Behavior Technician (RBT)- Clarksville
LittleStar ABA Therapy —Clarksville, IN
- $17 - $25 an hour
- Full-time
- 18 years or older
- Clean driving record
- HIPAA
- Mileage reimbursement
Quick Apply
14d
Insurance Account Representative - State Farm Agent Team Member
Tracy Haus - State Farm Agent —Louisville, KY
- $65,000 - $100,000 a year
- Full-time
- Office
- Leadership
- Marketing
- Health insurance
- 401(k)
Quick Apply
Financial Advisor
Northwestern Mutual —Louisville, KY
- $61,000 - $250,000 a year
- Full-time
- Background check
- Mid-level
- Office
- Health insurance
- Dental insurance
1d
Program Lead-PB Rehab PT
Powerback Rehabilitation —New Albany, IN
- $43.25 - $47.00 an hour
- Full-time
- Customer service
- Physical & Rehabilitation Medicine
- Mid-level
- Relocation assistance
- Health insurance
Financial Advisor with Accelerated Path to Management
New York Life Insurance Company & NYLIFE Securities, LLC —Louisville, KY
- $60,000 - $250,000 a year
- Full-time
- Background check
- Mid-level
- Business development experience
- AD&D insurance
- Disability insurance
Quick Apply

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Health Plan Member Services Analyst

Abilis Health Plan
Louisville, KY

Apply Now

Job Details

Full-time

Benefits

Health insurance
Prescription drug insurance

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
High school diploma or GED

Full Job Description

Our Company:

Abilis Health Plan

Overview:

The Member Services Analyst for the Institutional and Institutional Equivalent Special Needs Plan (I/IE-SNP) serves as the primary point of contact for membership operations. This role is responsible for delivering exceptional, person centered service to a uniquely vulnerable population by addressing inquiries related to benefits, authorizations, enrollments, claims, grievances, and appeals in full compliance with CMS regulations and the plan's Model of Care (MOC).

This position collaborates closely with Interdisciplinary Care Teams (ICTs), facility staff, authorized representatives, family members, and internal teams to ensure members concerns are resolved timely.

Responsibilities:

Member Inquiry & Benefits Navigation

Provide accurate, timely, and empathetic information on Medicare Advantage benefits
Assist members and representatives in understanding the plan’s benefits and services.
Facilitate enrollment, disenrollment, and plan change processes.
Serve as a liaison between members, authorized representatives, facility nursing and social work staff, and the plan's Interdisciplinary Care Team (ICT) to support care coordination activities.
Communicate relevant member service issues, unmet needs, or quality concerns to assigned Care Managers or Case Managers for clinical follow-up.
Assist members and facility staff in understanding prior authorization requirements and status for institutional and ancillary services.
Route authorization requests to the appropriate Utilization Management team and communicate status updates to requesting parties.
Maintain complete and accurate records of all member interactions in the plan's CRM or member management system in accordance with CMS and internal documentation standards.
Adhere to all HIPAA privacy and security regulations in handling Protected Health Information (PHI).
Complete all required CMS and plan-mandated training on an ongoing basis, including Annual Compliance Training, SNP-specific training, and Medicare Advantage regulations.
Support audit readiness by ensuring documentation quality and accuracy consistent with plan policies.

Grievances, Appeals & Coverage Determinations

Intake, document, and process member grievances and appeals in accordance with CMS regulatory timeframes (standard and expedited).
Explain member rights under the Medicare Advantage Appeals and Grievance process, including the right to request an Independent Review Entity (IRE) review.
Coordinate with the Medical Management, Claims, and Compliance teams to ensure timely resolution and member notification.
Track and monitor open cases to ensure adherence to required CMS timelines; escalate as needed.

Member Outreach & Education

Educate members and facility staff on how to access plan services, how to request care, and how to use the plan's provider network.
Assist with Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) distribution and answering related questions during open enrollment periods.
Coordinate and host facility and community member engagement events.

Qualifications:

High school diploma or GED required; Associate's or Bachelor's degree in Healthcare Administration, Social Work, Business, or related field preferred.
Minimum of 2 years of experience in a healthcare member services, customer service, or health plan operations role.
Prior experience in a Medicare Advantage, managed care, or long-term care/post-acute environment strongly preferred.
Strong verbal and written communication skills with the ability to communicate complex benefit information in plain language.
Demonstrated empathy and person centered communication skills, particularly with vulnerable elderly or disabled populations.
Proficiency with CRM systems, member management platforms, and Microsoft Office Suite (Word, Excel, Outlook).
Ability to manage a high volume of contacts while maintaining quality and regulatory compliance.
Strong attention to detail and organizational skills, with the ability to prioritize and meet strict regulatory deadlines.
Ability to work collaboratively within a multidisciplinary team environment.

About our Line of Business: Abilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year-round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet each member’s clinical needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com. Follow us on LinkedIn.

Apply Now

Refine Your Search

member services representative jobs in louisville, ky

Health Plan Member Services Analyst

Customer Service Representative

Part-Time Member Service Representative/Teller- Louisville, KY

iPay Call Center Representative (CCC)

Therapist / Social Worker- Deaf and Hard of Hearing

Clinical Pharmacist

Service Maintenance Technician

Hyper Wellness Representative

Registered Dietitian / Nutritionist - Full Time $10K SignOn-Kindred Hospital at Jewish Hospital

Clinical Pharmacist- Per Diem

Executive Director

Wealth Management Trainee (KY)

Sales Representative

Hotel Valet Attendant - Hotel Distil and Moxy Louisville

Car Hauler Mechanic

Registered Behavior Technician (RBT)- Clarksville

Insurance Account Representative - State Farm Agent Team Member

Financial Advisor

Program Lead-PB Rehab PT

Financial Advisor with Accelerated Path to Management

I want to receive the latest job alert for member services representative in louisville, ky

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