The Member Services Representative II is responsible for providing outreach to ArchWell Health members to help them navigate the complex healthcare delivery system. This will entail verifying their primary care physician and eligibility, and contacting their insurance plan when applicable to ensure they are assigned to ArchWell Health. This role has the potential to handle provider data management and will need to verify provider information with these insurance partners when applicable. An ideal candidate will have a deep understanding of the healthcare ecosystem, have strong attention to detail, and be driven by a passion for providing quality care to seniors.
The Member Services Representative II will have a demonstrated deep understanding of all aspects of the Member Services Representative role and ArchWell Health. This individual will have consistently achieved above average metrics in the Member Services Representative position. This role will be able to independently use resources available to answer questions about process and will be able to support other members of the team to find solutions. The ideal candidate will have a proven ability to think critically using guidelines to solve problems.
Duties/Responsibilities:
- Assist department leadership with the training and support of Member Services Representatives on team processes and workflows
- Provide ongoing guidance and mentorship to team members regarding best practices and workflows
- Outreach to members and insurance partners over the phone to verify members are assigned to ArchWell Health and schedule members for appointments
- Complete proper documentation of all member and payor outreach in various platforms
- Assist members in problem solving potential issues related to the health care system
- Validate provider data on file with insurance partners
- Utilize and manipulate shared Excel spreadsheets to track membership and interactions
- Manage tasks using Stonehenge application
- Communicate with center-based colleagues to appropriately assist members
- Maintain knowledge of current workflows
Required Skills/Abilities:
- Proficient PC skills to include Microsoft Office, Excel, and Teams
- Passion for helping senior members successfully carry out care plans
- Ability to work effectively with diverse populations including staff, providers, members, family members, insurance carriers, vendors, and the public
- Basic medical terminology
- Understanding of Medicare Advantage
- Working knowledge of eCW, Stonehenge, Genesys, and other required platforms
- Demonstrate leadership skills in a team setting, even without direct authority
Minimum Qualifications:
- High school diploma or equivalent education (GED) required
- Minimum of 1 year as Member Services Representative at ArchWell Health
- Embodies and serves as a role model of ArchWell Health’s Values:
- Be compassionate
- Strive for excellence
- Earn trust
- Show respect
- Stay resilient
- Always do the right thing
About ArchWell Health:
At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.
Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.
ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.
