Member & Provider Service Representatives

Job Description

JOB DETAILS

REQUIREMENTS

• High school diploma or equivalent required, bachelor’s degree preferred
• Prior professional work experience, ideally with customer service
• Outstanding customer service skills
• Excellent verbal and written communication skills
• Strong organizational skills with the ability to prioritize a high volume of adjustment requests, multi-task and prioritize work
• Ability to make reasonable and sound business decisions based on established standards and guidelines
• Working knowledge of Microsoft Office products
• Bilingual in Spanish, Portuguese, Haitian Creole or other language is highly desirable
• Able to comfortably work from home with access to a high-speed internet connection
• Regular and reliable attendance
• Ability to work overtime during peak periods

RESPONSIBILITIES

• Customer Interaction & Problem Resolution:
  Own each customer interaction by utilizing the appropriate resources to accurately interpret and respond to inquiries. Deliver outstanding, empathetic service that fosters trust, builds loyalty, and contributes to member retention.
• Call Management:
  Respond to a high volume of inbound calls from members and providers, addressing a wide range of topics. Calls may vary significantly in length and complexity, requiring adaptability and attention to detail.
• Communication & Conflict Resolution:
  Apply strong interpersonal and conflict-resolution skills to manage challenging calls with professionalism, courtesy, and empathy.
• Accurate Documentation:
  Record call details and customer interactions accurately in accordance with departmental standards and compliance requirements.
• Collaboration & Teamwork:
  Work collaboratively with peers and cross-functional teams to resolve issues, contribute to shared goals, and foster a positive team environment.
• Performance Goals:
  Consistently meet or exceed departmental goals related to quality, productivity, customer satisfaction, and compliance.
• Flexibility:
  Support the department by performing additional duties as needed, demonstrating reliability and adaptability.

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