Member Services Representative

3 weeks ago


Springfield, United States Health New England Full time
Job DescriptionJob Description

SUMMARY: The Member Services Representative provides superior customer service to members, providers, and employer groups.

ESSENTIAL FUNCTIONS:

  • Responds to inquiries from members, providers, and employer groups, providing superior product and benefit information for multiple HNE plans
  • Researches and resolves complex member inquiries via telephone, member mail, e-mail and fax
  • Educates members, employers and providers regarding benefits, policies, and procedures
  • Meets individual and departmental standards
  • Researches and resolves complex pharmacy issues utilizing the Reclaims system and the HNE Pharmacy Services Department
  • Performs New Member Outreach Calls
  • Processes member transactions, including but not limited to PCP changes, demographic changes, ID card requests and membership material requests
  • Collaborates with Enrollment, Claims, Health Services, Pharmacy, Legal, and Sales to ensure that member issues are appropriately resolved
  • Adheres to all regulatory requirements relating to member confidentiality, documentation, quality, and inquiry response time

MINIMUM REQUIREMENTS:

Associates degree and at least two years of customer service/call center experience within the managed care, insurance, or related call center industries or an equivalent combination of education and experience.

  • Demonstrated listening and customer service skills
  • Very good verbal and written communication skills
  • Multi-tasking and detail oriented skills
  • Problem resolution skills
  • Very good interpersonal and negotiation skills
  • Good organizational ability
  • PC knowledge - preferably with the Microsoft suite of products

WORKING CONDITIONS: Works in a standard office-based environment

  • Irregular Schedule - Occasionally (1/4 - 2 1/2 hrs.)


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