Member Services Respresentative

Summary of Position: Provides personalized service to members and other SummaCare customers and promptly works to answer questions and resolve concerns. Minimum Qualifications: a. Formal Education Required: a. High School Diploma or equivalent b. Experience & Training Required: a. Minimum of one year of experience performing same or similar responsibilities. Relevant experience includes: Customer service experience in an information management industry including call-center receptionist or administrative support experience that includes customer service responsibilities. Experience in health insurance/healthcare preferred. c. Other Skills Competencies and Qualifications: a. Demonstrate knowledge of Member Services practices. 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 machines. 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. 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) Provides personalized service to members by phone or electronically regarding information questions and problems concerning enrollment benefits eligibility billing claims and authorizations. 2) Records all member inquiries and complaints in tracking system and routes appropriately for resolution. 3) Meets or exceeds departmental production and quality standards (telephonic and written) required for a level I representative as defined in Departmental Policy & Procedures. 4) Treats all members with respect and consistently utilizes the three Es (Empathy Education and Empowerment) in all communications. 5) Maintains and demonstrates basic knowledge and understanding of Plan Central and Macess systems to resolve customer inquiries. 6) Performs all job functions with integrity. Provides timely internal and external customer service in professional and cooperative respectful manner. 7) Moderate Complexity: Independent judgment decision-making problem solving are made in accordance with demands of task being performed and/or interpreting procedures to appropriately perform responsibilities of the job. 8) Moderate Stress: Work requires close concentration and attention to detail; requires performing multiple tasks; may require maintaining quotas; may coordinate work/projects within department; accountable for personal performance and occasionally accountable for performance of others within department.