Experience

UFCW & Employers Trust, LLC

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Healthcare Representative

  • Aug 2022 - Present

  Member Service Representative assists members with all aspects of the Plans’ health and welfare benefits and resolves a broad range of questions and problems received from members, beneficiaries, union locals, service providers and other departments of the Fund office Communicates via telephone, in person and written correspondence, answers questions from members, beneficiaries, union locals, providers and other Fund office departments regarding the Plans’ benefits, eligibility, claims processing and claims appeals Obtains all pertinent information to determine specific purpose of call and/or walk-in Writes an eligibility appeal, sick leave and/or basic medical appeal if necessary Initiates and prepares correspondence and other documentation to resolve questions and provide information to members and others in accordance with Health Plans rules, regulations, and practices Initiates and reviews various applications, notices, forms, certifications, self-payments, COBRA, stop payments, clear claim notices Identifies and corrects information on Computer system and /or refers to appropriate staff for correction Determines eligibility in accordance with Plan rules and resolves eligibility issues and questions Confirms or denies coverage based on eligibility rules of the members plan Maintains appropriate documentation of all calls & walk-ins Handles walk-ins in a courteous and professional manner Discerns needs and verifies forms from a walk-in and refers to appropriate personnel based on walk-ins needs Acts as liaison between member and provider to communicate Plan benefits and facilitate claims processing Calculates sick leave banks Refers calls, members, union locals and others to appropriate department Assists with special projects as requested Show less