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Senior Member Services Representative - Member Services - Full Time - Days

Maumee, Ohio
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Description

For more than 30 years, Paramount, ProMedica’s health plan, has offered health insurance products across six Midwest states. Paramount is an Ohio-based health insurance company, headquartered in Maumee. Our team of more than 800 employees is dedicated to serving our health plan members.

Paramount offers Medicare Advantage, Medicaid managed care and Marketplace Exchange health plans for individuals and families. We maintain accreditation by the National Committee for Quality Assurance (NCQA) for our HMO, Medicare Advantage and Medicaid products. 

We also offer a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation as well as vocational rehabilitation, life-care planning and wellness.

As a part of ProMedica, we are driven by our Mission to improve your health and well-being. ProMedica is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. At Paramount, we strive to provide an exceptional experience to every member. For more information about Paramount, please visit our website. 
 

 

Basic Purpose:

To assist in the coordination of enrollment functions of the Membership Department. To ensure accurate and timely processing of new members, member terminations, contract type changes and group fact sheets for Paramount Health Care groups. The position reports directly to the Member Services Team Leader. No positions report to this position.

 

Primary Duties: 

  • Manual Functions: Receive, date stamp and code all enrollment applications, change forms, terminations and group Fact Sheets. Validate the accuracy of membership enrollment, membership changes, number of members and contract types reported by employer groups on a monthly basis via third party administrators or reports. Assign group numbers to all new groups. Accurately sort and prepare enrollment/change forms for scanning. Re-address misdirected mail. Mail new member kits with ID cards as well as reissued ID cards. Send termination notices to terminated members.
  • Data Entry: Enter into data base all new applications, changes forms,  group Fact Sheets and new divisions, group renewals rates and contract types, member and group terminations, new effective dates and pool transfers maintaining  a 2 day turnaround time. Comply with departmental audit procedures. Achieve at least minimum quality and productivity standards.
  • Phone calls and research: Initiate communications and establish working relationships with group contacts and/or Paramount’s governmental product departments to obtain required information, verify coverage/benefit packages, and provide education on enrollment regulations and proper form usage. Maintain documentation of ongoing status of dependent students as appropriate through communication with members/groups.
  • Maintain up to date familiarity and enforcement of company policies which includes obtaining additional documentation when appropriate. Also, maintain up to date familiarity with the AMISYS system requirements.
  • Use problem-solving skills, facts and data to seek appropriate solutions to all members and or group enrollment inquires and follow-up on a timely basis.
  • Assist in the development and training of enrollment functions as they pertain to Paramount’s corporate goals and objectives and departmental procedures.
  • Provide initial training to new employees and create training manual for the department with annual updates for departmental procedures.
  • Treats others with respect, courtesy, and honesty. Respects, values, and actively supports the contributions and diversity of all team members. 
  • Perform other duties as directed.
  • Assist the Team Leader.

  • High School diploma or GED and minimum of two years’ experience in a membership role required. 
  • Three (3) years’ experience in a health care or insurance system environment in membership required.
  • Expert knowledge of all Paramount Product lines, member policies & procedures required, having consistently met or exceeded departmental performance standards.</li>
  • Excellent communication skills, good grammar, problem-solving and organizational skills required.
  • Experience in Amisys and Macess required.
  • Computer skills- Knowledge of Word, Excel and Outlook
  • Excellent PC entry skills required; typing minimum 40 words per minute required. 
  • Excellent communication (oral and written) and organizational skills required.
  • Ability to move between company workstations and departments.
  • Ability to answer, and communicate on phone, fax or via email. 

 

 

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

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