Department:
Member Services
Reports to:
Operations Supervisor
Description:
Entry level, fully trained Member Services Representative to respond to member/provider inquires, whether of a substantive nature, a procedural nature, or both. The position provides customer service to all inbound calls as well as making outbound/outreach calls when necessary. All calls routed through an Automatic Call Distribution (ACD) system, from members and/or providers on a variety of topics to educate them on benefit issues, claims inquiries and collect feedback.
Responsibilities:
- Complies with HIPAA/PHI regulations in all interactions with internal (representative from other departments) as well as external (members/providers).
- Handles and/or exceeds average of 45 inbound calls a day, while meeting the service standards.
- Ability to meet the minimum QA audit scoring criteria. 80% or higher
- Attends to the members/providers inbound calls to assist with any appropriate information about benefits, provider and customer service issues.
- Documents details of all calls in the appropriate system and routes issues to appropriate department for follow up, when/if necessary.
- Follows up on pending unresolved issues.
- Provides expertise and customer service support to internal customers.
- Documents complaints and grievances in the appropriate systems and forwards to the appropriate entities.
- Meets and maintains tardiness and attendance standards set by department policy.
- Performs other duties and activities as deemed necessary.
- Performs other duties as assigned.
Minimum requirements:
- Ability to quickly and easily develop relationships
- Must be able to multitask and be prepared to manage a wide variety of responsibilities that can change on a daily basis
- Must work well with internal and external resources and counterparts
- Strong team player that is focused with a strong work ethic
- Excellent written and verbal communication skills
- Microsoft office expertise – word, outlook and excel
- Excellent interpersonal skills.
- Professional organizational, oral and written communication skills.
- Ability to listen, document and track problems within the appropriate systems, simultaneously while on calls.
- Ability to respond in difficult situations on the telephone calls. Maintain flexibility and a “can do” attitude supporting department goals and objectives.
- Able to commit to overtime as needed and/or shift changes.
- Successfully complete in-house training program (90% or better on final test).
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