Company: Capital District Physicians' Health Plan, Inc
Posted on: June 14, 2019
CDPHP is a healthcare leader in the Capital Region, with
participating providers in 24 counties in upstate New York. As a
company, CDPHP emphasizes the member experience as well as employee
engagement. With over 1,000 employees at our corporate headquarters
in Albany, we are still managed by a board of physicians, and
maintain a strong emphasis on patient care. We value integrity,
diversity, and innovation, and a corporate culture that supports
those values. At CDPHP, employees have the opportunity to make an
impact both at the company and community levels. We strive to
provide knowledge and display excellent in all that we do, and are
looking for motivated individuals who want to be a part of that
The Member Service Representative shall assume full responsibility
and ownership for all aspects regarding education of the member,
the Employer Groups, Brokers and/or prospective members regarding
the proper utilization of the Plan. In addition, the incumbent will
address and resolve service problems, complaints, and advise the
customer of their rights and responsibilities. The Member Service
Representative will work closely with all departments, such as
Marketing, Enrollment, Pharmacy (internal and external), Provider
Services, and Claims Operations to resolve member inquiries as
defined within Member Services Procedures. The incumbent will also
review eligibility requirements, provide rates for various health
products, provide usual and customary rates based on procedural
codes, and assist prospective members with enrollment applications
as requested by the customer. Representatives are required to
handle multiple product lines, complete system updates and respond
to members via telephone and correspondence.
* High School diploma or GED with 2 years customer relations
* Experience with a documentation system to track inquiries
generated and received preferred.
* Strong working knowledge of Microsoft Word required.
* Demonstrated ability to determine, analyze and solve problems
related to benefits, claims processing, claims and benefit
appeals/complaints, enrollment and premium billing issues required.
Demonstrated ability to successfully apply problem solving and time
management methodology, balance multiple tasks as business needs
arise while maintaining production and quality standards and meet
* Ability to interpret all CDPHP s health plan contract language,
* Demonstrated ability to effectively communicate on a verbal and
written basis using appropriate grammar, spelling, punctuation and
sentence structure is required with members, providers, marketing,
pharmacists, governmental agencies and other persons associated
with CDPHP on the phone, written correspondence and/or face-to-face
while maintaining a professional approach is required.
* Strong attention to detail and capability to meet established
quality and productivity standards.
* Ability to complete system updates.
As an Equal Opportunity / Affirmative Action Employer, CDPHP will
not discriminate in its employment practices due to an applicant s
race, color, creed, religion, sex (including pregnancy, childbirth,
or related medical conditions), sexual orientation, gender identity
or expression, transgender status, age, national origin, marital
status, citizenship, physical and mental disability, criminal
record, genetic information, predisposition or carrier status,
status with respect to receiving public assistance, domestic
violence victim status, a disabled, special, recently separated,
active duty wartime, campaign badge, Armed Forces service medal
veteran, or any other characteristics protected under applicable
Keywords: Capital District Physicians' Health Plan, Inc, Albany , MS Representative, Other , Albany, New York
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