Member Services Representative II

3 months ago

Shrewsbury, United States UHealthSolutions, Inc. Full time
Job DescriptionJob Description

Member Services Representative II

UHealthSolutions is seeking candidates for several full-time positions within various programs within the Contact Center. These programs are designed to provide outbound and inbound call center services.

Position Summary:

The Member Services Representative II is primarily responsible for resolving general inquiries from customers utilizing subject matter expertise and available resources. UHealthSolutions provides these services 24 hours per day, 365 days per year for a variety of clients. Therefore, this position requires a particular emphasis on reliability and flexibility in work schedules and assignments in order to ensure that we meet contractual obligations across all operating hours.

Primary Responsibilities:

  • Resolve inbound and outbound contacts in accordance with established program policies, procedures, and standards
  • Provide customers with comprehensive assistance in obtaining access to benefits from a broad array of insurers, payors, providers and advocacy groups
  • Perform administrative functions, including but not limited to review of enrollment applications and documentation
  • Utilize provided scripts and procedures to provide customers with general information and exercise reasonable judgment to appropriately transfer / escalate more complex issues to the appropriate location for resolution
  • Perform basic administrative functions, including but not limited to filing, scanning of documents
  • Demonstrate consistent and professional customer service skills: active listening, ability to engage the customer, appropriate utilization of resources, clear written and verbal communication
  • Adhere to scheduled shift and break times
  • Log all contacts in accordance with established program policies, procedures, and standards

Employee Responsibilities

  • Achieve minimum productivity and quality standards for each task assigned
  • Actively participate in quality control/quality improvement initiatives
  • Participate in knowledge transfer / side-by-side “buddy” training, as directed
  • Attend and participate in meetings and training as directed
  • Maintain the confidentiality of all business documents and correspondence according to HIPAA, corporate, and program guidelines
  • Comply with established departmental policies, procedures and objectives
  • Comply with all health and safety regulations and requirements

Supervision Received:

Reports to Designated Contact Center Supervisor

Position Qualifications:

  • High school diploma or equivalent
  • Must read, speak and write English fluently
  • Bi-lingual proficiency preferred (Must read, speak and write Spanish fluently)
  • Must have at least 6-12 months of relevant experience in health care, call center, retail, hospitality, or corporate office. Knowledge of health care terminology is preferred.
  • Physical ability to stand and repetitively bend down and reach up for extended periods of time (e.g., for file room projects)
  • Must be flexible regarding hours scheduled (e.g., morning, mid-day, evenings, overnight, weekends, and holiday assignments)

Skills:

  • Ability to comprehend and communicate regarding complex program subject matter in order to resolve inquiries from callers in a timely and accurate manner
  • Ability to write narrative documentation of customer interactions using appropriate spelling, grammar, punctuation and professionalism
  • Ability to utilize customer service skills including the ability to relate well to diverse populations and to represent the organization professionally
  • Sound judgment and discretion
  • Ability to communicate clearly and effectively verbally and in writing
  • Accurate typing/data entry and information tracking skills at a minimum proficiency of 40 words per minute
  • Computer literacy including experience with Internet Browsers, Microsoft Outlook, Word, and Excel

COVID-19 Considerations:

  • All employees must show proof of vaccination or seek exemption or accommodation related to disability, medical or religious based reason(s) by their 1st day of employment.


The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified. UHS reserves the right to modify position duties at any time, due to business necessity.

UHealthSolutions is an equal opportunity employer and encourages applications from individuals with varied experiences and backgrounds .

UHealthSolutions is a Tobacco-Free Workplace.

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