Member Services Representative (Dearborn, MI) 

Exemption Status:  Non-Exempt 
Reports to:    Manager, Member Services 
Job Code:  Salary Grade:    Union – Grade 4

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

*Shift hours: Thursday/Friday 1:30am-12pm and Saturday/Sunday 8:00am-6:30pm EST.

The Member Services Representative will answer subscriber and provider questions about benefits, eligibility, claims and certification. Ensure customer satisfaction and promote a positive corporate public image. Screen incoming subscriber and provider calls/inquiries and take data to initiate cases. Quote accurate benefit and policy information regarding inpatient and alternative levels of care. Handle complicated inquires and educate providers/subscribers in the certification process and reconcile inconsistencies and procedural difficulties when necessary Perform all data entry for case initiation and update and enter data into system for non-participating providers. Special projects and all other duties as assigned.

How you will make an impact: ​​

• Perform responsibilities and tasks in ways that promote good will, build positive relationships, preserve human dignity, and contribute positively to the corporation service orientation.  
• Service calls in a professional and courteous manner.
• Perform review of service requests for complete information. 
• Answer telephone calls identifying those needing case management services, those needing referral to routine outpatient services, and those needing authorization and/or verification.  
• Answer questions from providers, members, insurance carriers and/or Beacon regional offices.
• Certify benefits per account for specific guidelines.  
• Provide a list of in-network providers to callers.  
• Explain the benefits and benefit maximums that have been reached.
• Verifies benefits against contract requirements prior to case initiation.  
• Refers complicated cases to Case Managers.  
• Collect and transfer non-clinical data.  
• Acquire structured clinical data.  
• Perform activities that do not require evaluation or interpretation of clinical data.  
• Attend all staff meetings, team conferences and in-service as directed.  
• Comply with all credentialing and other PSO requirements.  
• Assist to train new unit personally and to set up new clinical case management units as directed. 
• Assist in special projects as directed by the Department Manager/Supervisor.
• Assist clinical area managers to prepare for re-authorization of services by gathering necessary information and retrieving relevant subscriber files.  
• Assist to maintain subscribers’ files.  
• Assist Clinical Case Managers to complete claims investigations and facilities claims payment by verifying authorizations, verifying member eligibility, and researching provider information.
• Record complaints, grievances, and appeals.
• Collects demographic data from providers/subscribers for case initiation.  
• Completes data entry for authorizations.
• Perform data entry for case initiation and updates.  
• Research and investigate claims inquiries.  
• Document all inquiries.
• Apply Beacon policies and procedures consistently.
• Maintain confidentiality of Clients, Business Records and Reports.
• Maintain ethical and professional standards.
• Maintain individual productivity and performance standards.
• Meet Departmental expectations, accuracy, productivity, and performance standards.
• Support Beacon in achieving Mission Statement.
• Adhere to the components of the Compliance Program.
• Ensure that job tasks are performed in a legal and ethical manner.
• Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline.
• Adhere to compliance training requirements and understand that training is required condition of employment.
• Complete tasks accurately and within required timeframes.

Minimum Requirements

• High school diploma or a GED equivalent.
• A minimum of one year of customer service experience or experience in the behavioral health care field.
• Strong customer service orientation, and excellent written and verbal communication skills especially telephone service skills required.
• All applicants will be required to demonstrate their customer service skills by participating in a test phone call simulation.

Preferred Skills, Capabilities and Experiences

• Behavioral Health experience preferred
• Call center experience preferred

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.