Member Service Specialist

Confidential

Mount Clemens

Full Time

Expires On: 05/08/2026

Job Description

Job Description

POSITION SUMMARY:

Effectively manage member needs and benefits by providing answers to patient questions, process claim adjudication, and manage plan enrollments. Maintain provider relations by creating authorization numbers, complete provider credentialing, maintain contracts, and location updates.

DUTIES AND RESPONSIBILITIES:

• Answer Member Services queue line in a timely manner. Assist patients with eligibility, benefits, locating stores, and resolving problems

• Maintain all providers on CAQH and Gemini for credentialing. Update provider information in software, on directory, and on website. Follow up with providers regarding missing information, record due, and completion of credentialing

• Review and research upload errors from retail location. EDI claim through TriZetto. Complete rejection letters and maintain rejection log. Partner with providers to resolve claim errors

• Maintain contracts with groups and brokers

• Process end of month payout. Review all claims for accuracy, generate appropriate reports, submit affiliate and referral claims to Accounts Payable department for

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