Member Services Representative I

2 months ago

Smithfield, United States Neighborhood Health Plan of Rhode Island Full time

The Member Service Representative I should possess a genuine desire and commitment to assist members and support the mission, vision and values of Neighborhood. He/she is the most junior level call center service representative who is responsible for telephonically working with members.

**Duties and Responsibilities**:
Responsibilities include, but are not limited to the following:

- Answers a high volume of calls from members and pharmacies
- Use active listening skills, demonstrate patience and empathy, and is able to handle difficult customers courteously and professionally
- Meet or exceed department established key performance indicators
- Adheres to assigned schedules to ensure appropriate phone queue coverage
- Employs active listening skills, demonstrates patience and empathy, and is able to handle difficult customers tactfully, courteously and professionally.
- Interacts with other internal departments to resolve issues
- Provides accurate documentation regarding the inquiry in the Customer Service Call Tracking Applications
- Uses knowledge of Neighborhood organizational structure, Member Services workflow and operating procedures to resolve members issues
- Works effectively in a team environment
- Represents Neighborhood to internal and external customers in a professional manner
- Assists with completion of projects/programs as necessary
- Perform other assigned tasks as needed
- Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

**Qualifications**

Required:

- High school degree or equivalent
- Minimum of one (1) year phone and/or customer service experience
- Attention to detail
- Excellent written/communication skills
- Strong listening skills
- Beginner/Intermediate proficiency on MS Windows
- Demonstrated ability to navigate multiple systems

Preferred:

- Managed care experience
- Knowledge of Neighborhood organizational structure, Member Services workflow and operating procedures
- Strong organizational skills
- Knowledge of Member Services Service Levels and NCQA/HIPAA Standards
- Proficient in handling the Medicaid lines of business
- Bilingual

**Flexible Work Arrangement**:
**Telecommuting Arrangement**:

- This position works 100% remote and is assigned to a Permanent Remote Team. The training is in-person and will last about 6 weeks. Occasional in-person days may be required.

**Training Dates (Monday-Thursday in-person, Friday remote)**
- Start Date 6/24/2024
- Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis._

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