Member Out of Pocket (MOOP) Customer Services Specialist - Managed Care - Position #2019-192


Date Posted:
Full Time
OPEN UNTIL FILLED - Redlands Monday - Friday 8:00a.m. - 5:00p.m.

Job Description


The Member Out of Pocket (MOOP) Customer Services Representative serves as a point of contact for all Managed Care Health Plans, Members and Providers. They will be responsible for resolving complaints and inquiries regarding authorization, billings and claims, as well as the Member Out of Pocket (MOOP). They will be required to run reports, researching member’s accounts in McKesson and EX Cap, send notifications to internal staff and external clients/providers, and process any copay refunds to Members and Providers.





High School Diploma or equivalent. Associate’s Degree in Business Administration or similar field preferred. Three years of Claims Processing or Medical Billing experience in a healthcare industry required. Experience with corrections, distributions, reversing payments and requesting refunds is preferred. Must have knowledge of EZ Cap, McKesson or other Claims/Practice Management Systems. Thorough knowledge of insurance benefits covered by contracting health plans.  Must be proficient in the application and use of Windows, Word/Excel, Outlook and the internet. Must be able to independently set priorities, work with high level of detail; strong database & spreadsheet skills a must. Ability to maintain accuracy and detail orientation when analyzing data and other information; to multi-task in an efficient, thorough, and prioritized manner; to work quickly, accurately and independently; and, to anticipate needs and solve problems. Ability to organize to achieve a specific objective. Strong verbal and written communication skills. Strong analytic and problem solving skills required. Ability to effectively communicate with a wide range of customers with consideration of their educational, ethnic, cultural and language differences.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Applications must be complete and demonstrate that the minimum qualifications are met. Resumes may be attached to completed application form as supplemental information, but will not be accepted in lieu of an official application form. Applications will be screened and the most qualified candidates who best match the needs of the position will be invited to compete further in the recruitment process.  Due to the large volume of applications received, we are unable to track for individual applications or discuss the application process.