PacificSource Health Plans · 9 hours ago
Individual Membership Representative I
Springfield, OR
Full-time
Onsite
Entry Level
$32K/yr - $52K/yr
1+ years expPacificSource Health Plans is dedicated to helping members access quality, affordable care. The Individual Membership Representative I is responsible for providing professional customer service to individual applicants and members, processing enrollments and changes, and managing various administrative tasks related to individual health plans.
CommunitiesCustomer ServiceNon Profit
Responsibilities
Process individual enrollments, changes, and terminations for subscribers and dependents via email, fax, mail, spreadsheet, 834 files, Online Enrollment System (OES), InTouch, and other formats. Use applicable policies and regulations to determine eligibility for enrollment. Obtain missing information by contacting members and producers
Answer incoming calls, documenting each call in Facets
Audit and review new policies and all pertinent documents using systems including PacificSource Enterprise (PSE), OnBase and Enrollment Management System (EMS)
Process Discretionary Billing Items, refunds, cash transfers, and write offs as needed
Monitor e-mail queue and provide e-mail support to agents, members and internal customers regarding eligibility, status of applications and other various requests
Generate correspondence following company guidelines, ensuring consistency and accuracy
Maintain accuracy standards as required to meet department and PacificSource PRISM measures
Complete all daily, weekly, bi-monthly and monthly reports for active and terminated members
Electronically upload images into imaging system. Prepare documents for manual imaging if needed
Set up and maintain transactions including Electronic payments, Electronic Fund Transfer (EFT) records, Recurring Payments, Insufficient funds in system. Audit file of electronic funds transfer transactions
Meet department and company performance and attendance expectations
Attend team, department, company meetings, and mentor lessons as scheduled
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
Review, update and maintain policy and procedures as needed
Perform other duties as assigned
Qualification
Required
Minimum of one year prior customer service, medical insurance or other healthcare related experience required
High School diploma or equivalent required
Must possess excellent communication skills both verbal and written
Basic excel knowledge
Strong keyboarding skills
Problem solving skills
Ability to multi-task
Ability to effectively articulate rates, contract provisions and processes to internal and external customers
Ability to adhere to company and department policies and meet expectations for service, accuracy and efficiency
Ability to define and prioritize problems and manage workload without direct supervision
Preferred
Insurance or healthcare experience preferred
Company
PacificSource Health Plans
Founded in 1933, PacificSource is a not-for-profit health insurer for people and organizations throughout the Northwest.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
John Espinola MD MBA
President and CEO
Erick Doolen
Chief Operating Officer
Recent News
2025-11-29
2025-10-22
Company data provided by crunchbase