Member Services Representative

Job Description

REQUIREMENTS

• 2+ years of customer service or call center experience preferred
• 2+ years of experience in the health care industry or insurance environment preferred
• Associates degree in lieu of experience will be considered
• Education High School Diploma or Equivalent Required Notes: Business-related college courses preferred. Associates degree highly preferred
  

RESPONSIBILTIES

• Provide timely and accurate information to basic incoming customer calls from members, providers, and other external & internal constituents including:
• Issuing authorizations
• Handling claims inquiries from providers and members
• Communicate the correct information regarding accessibility, claims status and other calls of a service nature
• Providing benefits information
• Process customer claims according to established department policies and procedures
• Checking voicemail boxes and handling customer/provider requests for:
• I.D. cards
• Authorizations
• Customer Service questions and issues
• Fulfill rapid call volume by handling the appropriate number of calls coming into the call center daily
• Complete Provider Relations requests for service
• Provide timely feedback to the company regarding customer service failures and/or customer/provider concerns
• Partner with Sales and Provider Relations to meet and exceed customers’ expectations
• Provide excellent customer service and handle all customers in a professional and courteous manner
• Perform other duties as assigned

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