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Member Services Representative

Recruitment #121116-UNCA-23


A resume and cover letter must be submitted along with your application.

The Office of Management and Enterprise Services - Employee Group Insurance Division, is seeking an experienced Member Services Representative for our Member Services Department at Landmark Towers. This is a full time, unclassified position in State government and will be eligible for a generous total rewards package. Benefits include medical, dental, life, and disability insurance products as well as defined benefit and defined contribution retirement plans.  Employees earn 3 weeks paid annual and 3 weeks sick leave in the first year as well as enjoy 11 paid holidays annually, flexible work hours, comp time, longevity pay and tuition reimbursement.
This position is considered a plan liaison to employers, employees and categories of former employees, dependents or survivors.  Provides guidance through individual and group enrollments, membership rules and benefits information to eligible jurisdictions.  In the accepting of an assignment of participating employers, is responsible for establishing and maintaining contact with both external and internal customers concerning eligibility, member or agency processes to access benefits or problem resolution or training coordinators on qualifications for membership.  As a Centers for Medicare and Medicaid Services contracted employer prescription plan, federal or state laws, industry practice and Rules of the plan are enforced.

Principal Responsibilities: 
• Provides authoritative oral or written responses to inquiries from all sources on eligibility, enrollment, change and termination processes; insurance applications for retirement, vesting, survivor or COBRA continuation; premium reconciliation processes; plan benefits and issues; and service access for one or more insurance and benefit plans; makes oral presentations in group settings before members, and other authorities.

• Determines eligibility for participation for individuals; resolves problems on eligibility or plan benefits/claim issues for active, retired, vested, COBRA, disabled, survivor or Medicare Supplement member categories.

• Interprets or explains policies and procedures, including federal and state laws, and regulations, to prospective and participating member; contributes to policy changes as reflection of the federal or state legislation or regulation creating an impact to the plan or the membership.

• Maintains records of contacts with all sources, reviews records; prepares and analyzes statistical data; advises supervisors of significant changes and deviations from standards.

• Makes field visits to employer sites throughout the state for service to coordinators and members; performs insurance coordinator training at individual or group level, including all aspects of eligibility, enrollment and benefit processes, employee orientations and annual enrollments; presents insurance eligibility and benefits in pre-retirement sessions and to retired organization meetings.

Minimum Qualifications:
Four (4) years of experience in an insurance related customer service position; or a bachelor’s degree in business administration, marketing or public administration; or an equivalent combination of education and experience.

Minimum Salary up to $39,600

OMES is an Equal Opportunity Employer. Reasonable accommodation to individuals with disabilities may be provided upon request.


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