The Member Services Representative is responsible for all customer requests received by the department via telephone, email, and mail. Monitors all communications related to the intake of information and delivers timely, accurate, and professional service to all customers. Contacts customers in order to resolve all patient account and Provider inquiries. The Member Service Representative also supports and collaborates with department Managers to ensure the daily functions of the department are met.
ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
1) Assists members with complex benefits questions and inquiries concerning member eligibility, benefits, claim status, and demographics.
2) Responds and assists members (patients) with Primary Care Provider (PCP) allocation.
3) Handles incoming and outgoing phone calls, emails, paper mail, and faxes related to Member Services.
4) Performs analysis, research, and determinations to ensure effective customer service and issue resolution.
5) Monitors queues to ensure member and Provider inquiries are handled professionally and in a courteous, responsive, and timely manner.
6) Monitors and run reports to ensure staff quality is within department standards.
7) Arranges interpretation services for members as needed.
8) Assist with special projects, reports and coordinates with other department leaders as needed.
9) Other various duties as assigned, including cross training in other functional areas.
EDUCATION: High School Diploma or equivalent required.
EXPERIENCE: Minimum 1 year of customer service experience in a healthcare setting required, 2-3 years previous healthcare experience preferred.
KNOWLEDGE, SKILLS AND ABILITIES
* Skill in defining problems, interpreting billing information.
* Ability to multi-task in a face paced environment while meeting established production and quality goals/metrics.
* Strong organizational skills, with ability to effectively prioritize work on a daily basis and follow up on open items in a timely manner.
* Must have strong verbal, written, and interpersonal communication skills.
* Demonstrates ability to work well in a team environment.
* General PC knowledge including Microsoft Office, Internet and Email.
TYPICAL WORKING CONDITIONS
* Hybrid (rotates working remotely and in office - US based)
* Indoor Work
* Operating Computer
* Reach Outward
* Manual Dexterity
* Lift/carry 10 lbs. or less
* Reach above shoulder
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.
Demonstrate good judgement and reads and abides by the company’s code of conduct, ethics, employee handbook, policies and procedures and other corporate mandates