Job Title: Member Services Representative- Health Benefits TPA

Department: Call Center / Claims

Work Environment: Remote

Company Overview

ASR Health Benefits is a third-party administrator (TPA) based in Grand Rapids, Michigan, with over 40 years of experience helping organizations manage health and benefits programs. Unlike an insurance carrier, the organization partners directly with employers to design flexible, customized benefits solutions. Backed by Henry Ford Health, one of the nation's leading health systems, ASR offers access to an extensive network of resources and high-quality care. Services span self-funded medical plans, dental, vision, wellness, and a range of health benefits solutions designed to support diverse workforces. The company is focused on making benefits administration simpler, more effective, and more responsive to client needs.

Position Summary:

The Member Services Representative (MSR) is responsible for providing specialized call management, advocacy, and education to members, ensuring excellent customer service in alignment with company mission and values.

The MSR serves as the point person for member inquiries, issues, and concerns, guiding them through their claims and assisting with timely resolutions. This role requires strong communication skills, critical thinking, and the ability to work collaboratively within the claims unit to foster positive member experiences.

Key Responsibilities:

Case Management & Advocacy: Manage assigned member caseload using a high-touch advocacy model to enhance the member experience and encourage engagement.

Customer Service: Providing quality customer service while assisting members on the phone with benefit questions and claim status.

Claims Assistance: Apply independent judgment and problem-solving skills to assist members with their claim inquiries, ensuring positive outcomes.

Issue Resolution: Act as the primary point of contact for escalated member issues, ensuring timely resolution through coordination with internal and external parties.

Cross-functional Coordination: Facilitate communication among members, internal staff, and providers as needed, escalating issues to supervisors or legal when necessary.

Documentation & Tracking: Maintain accurate and detailed records of member inquiries and resolutions using WebCSR software. Document all stages of the process and ensure timely follow-ups.

Collaboration: Work closely with internal departments to address service issues and identify opportunities for process and systemic improvements.

Claims Processing: Assist in claims processing as needed, including validating medical, dental, vision, flex, and HRA claims. Apply knowledge of HIPAA regulations when handling sensitive information.

Problem Solving & Compliance: Identify and resolve claim issues, including duplicate claims, late charges, and incorrect billing, while adhering to HIPAA guidelines.

Data Entry & Proofreading: Ensure all claims information is complete and accurate; proofread manually entered claims.

Goal Achievement: Meet daily production and performance goals while maintaining a high level of accuracy and quality in all tasks.

Preferred Skills and Qualifications

• Skills
• • Strong verbal and written communication skills.
  • Proficiency in Microsoft Outlook, Word, Excel, and internet navigation.
  • Ability to multi-task in a fast-paced, deadline-driven environment.
  • Experience in billing, insurance, healthcare, or legal environments is a plus.
  • Familiarity with UB-04 and CMS-1500 billing forms is a plus.

• Knowledge
• • Strong understanding of HIPAA regulations.
  • Knowledge of claims processing and healthcare claims systems.

• Attributes
• • Ability to work independently with limited supervision.
  • Strong problem-solving skills and critical thinking.
  • High attention to detail and ability to manage competing priorities.
  • Demonstrated success in client-focused solutions.

• • Agreement that your likeness (e.g., name, image, voice, and/or video) may be used in internal and external materials with customers or prospective customers.

Preferred Education and Experience:

• High School Diploma or GED required; Bachelor’s degree preferred.
• Minimum of two years in a claims processing, data entry, or customer service role within a TPA, insurance company, or healthcare environment.

Work Environment:

This position follows a remote work structure, allowing employees to work from home, based on specific tasks or personal work preferences. There may be times when working in the office will be required.

Essential Functions:

This role may require extended sitting, regular computer and office equipment use, clear communication, and occasional lifting of up to 10–15 pounds. Reasonable accommodations for individuals with disabilities will be provided as needed.

Confidentiality: This position involves access to protected health information (PHI) and other sensitive data. Employees are expected to maintain strict confidentiality in accordance with HIPAA, company privacy policies, and all applicable federal and state regulations.