Member Services Representative

First Connect

🇺🇸 United States
On-site
4 months ago

Windows

Health insurance

4 months ago

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Provides personalized service to members and promptly works to answer questions and resolve concerns. Coordinates with management and other departments to effectively address member needs. Minimum Qualifications: a. Formal Education Required: a. High School diploma or GED; College experience preferred b. Experience & Training Required: a. More than 2 years of experience performing same or similar responsibilities. Relevant experience includes: Customer service including call-center or administrative support experience and background in Medicare and/or health insurance strongly preferred. c. Other Skills, Competencies and Qualifications: a. Demonstrate knowledge of Customer Service practices, including phone system operations and documentation workflows b. Communicate effectively with others through written and verbal means. c. Facilitate working in Windows, and with organizing computer based information. d. Balance need for decisive, professional demeanor with warm, non-confrontational customer-first attitude. Project empathy, confidence, proper tone, and service-oriented attitude over the telephone. e. Operate standard office equipment such as a personal computer and headset; Adept keyboarding and computer skills, including wifi, VPN access, and audio controls. f. Demonstrates ability to learn and practice knowledge of health insurance industry, including governing rules and regulations. g. Organize and manage time in order to complete tasks within designated time frames in fast paced environment. h. Demonstrates ability to learn and practice knowledge of and complies with regulatory, departmental, and company policies & procedures. i. Ability to maintain confidentiality of member health information and business information. j. Flexible: ability to adjust work hours to meet business demands; comfortable in a remote work environment d. Level of Physical Demands: a. Sit for prolonged periods of time. b. Bend, stoop, and stretch. c. Lift up to 20 pounds. d. Manual dexterity to operate computer, phones, and standard office machines. Essential Functions: 1) Provide personalized service to members by phone, electronically, or in person regarding questions and issues related to enrollment, benefits, eligibility, billing, claims, and authorizations. 2) Record all member inquiries and complaints in the tracking system, ensuring accurate documentation and appropriate routing for resolution. 3) Meet or exceed departmental production and quality standards for telephonic and written communications, as defined by company policies and procedures. 4) Treat all customers with respect, consistently utilizing empathy, education, and empowerment in every interaction. 5) Maintain and demonstrate knowledge of health insurance industry practices, including governing rules, regulations, and internal systems such as Amisys and Macess. 6) Perform all job functions with integrity, providing timely, professional, and cooperative service to both internal and external customers. 7) Exercise independent judgment and problem-solving skills to address member concerns and interpret procedures appropriately. 8) Communicate effectively through written and verbal means, projecting confidence and a service-oriented attitude over the telephone. 9) Organize and manage time efficiently to complete tasks within designated time frames in a fast-paced call center environment. 10) Maintain confidentiality of member health and business information and comply with all regulatory, departmental, and company policies and procedures. Performs all job functions with integrity. Provides timely internal and external customer service in professional and cooperative, respectful manner. 11) Moderate Complexity: Independent judgment, decision-making, problem solving are made in accordance with demands of task being performed and/or interpreting procedures to appopriately perform responsibilities of the job.

VivPost

Member Services Representative · First Connect

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