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Member Services Representative I
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Alameda, United States Alameda Alliance Full timePRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a...
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Member Services Representative I
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Alameda, United States Alamedaalliance Full timeBrief Description PRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members’ primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and...
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Member Services Representative I
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Member Services Representative I
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Member Services Representative I
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Member Services Representative I
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Member Services Representative I
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Member Services Representative I
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Member Support Representative I
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Member Support Specialist I
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Member Services Representative I
1 month ago
PRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email, fax, letters, chat, and phone calls. Timely responses to all member communication are essential. Must effectively prioritize and flex the workload as new communication and tasks are submitted. Identify the caller's needs, clarify information, research issues, and provide solutions and/or alternatives whenever possible. Accurately and consistently document all conversations in the electronic database. This position is a liaison between the plan, the provider network, and other community agencies. The MSR positions are flexibly staffed classification and work is expected to be performed minimally at the MRS II level. However, the initial selection will be made at the entry level MSR I. Our more advanced level position of the series is the MSR III who will be required to perform a variety of complex matters. Member Services Representatives are under the direction of a Member Services Supervisor, Manager, and Director, and service our members through our call center as well assisting other departments with responses to member issues by initiating communication between departments to ensure action, cooperation, and compliance of managed care operations. Member Services Representative I: This position requires the ability to work as a team player within the Alliance and with external contacts, make sound judgments based on analysis of information, be an effective communicator, active listener and balance advocacy for the member with the policy provisions such as plan policies, EOC, regulatory guidelines, and DMHC/DHCS rules and regulations. The MSR provides courteous, professional, and accurate responses to incoming inquiries regarding network, plan benefits, eligibility, authorizations, plan services and guidelines, as well as making decisions with the goal of ensuring member satisfaction and retention. The MSR performs a variety of complex functions and is also responsible for maintaining accurate and complete inquiry/grievance records in the electronic database. Maintains compliance with DMHC regulatory requirements and DHCS contractual obligations. MSR I staff who demonstrate proficiency in meeting, maintaining and exceeding principal performance objectives and metrics may be eligible to be promoted to a Member Services II or III role. Member Services Representative I staff may be eligible for promotion to Member Services Representative II or III positions once they have worked as a MSR I for a minimum of 12 months to be proficient with program and system knowledge in addition to meeting performance matrix requirements. Principle duties and responsibilities: Serve as the primary contact for members, providers, and others for questions related to claims, benefits, authorizations, pharmacy, member eligibility and other questions related to Alameda Alliance and provide accurate, satisfactory answers to their inquiries or concerns. Respond to and resolve member service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, behavioral health, and care coordination. Answer incoming calls, emails, chats, and other requests for assistance in a timely manner in accordance with departmental performance targets and provide excellent customer service while doing so. May include assisting members in person. Recognize and understand the difference between calls that require quick resolutions and calls which will require follow-up and handle each appropriately. De-escalate situations involving dissatisfied customers, offering patient assistance and support. Accurately document all contacts per department standards/guidelines in the Customer Relationship Management (CRM) system. Interface with Grievance and Appeals, Claims, Enrollment, IT, Network Management, Pharmacy, Authorizations, and other internal departments to provide Service Excellence to our members. Help guide and educate members about the fundamentals and benefits of managed health care topics, to include managing their health and well-being by selecting the best benefit plan service options, maximizing the value of their health plan benefits, and choosing a quality care provider. Manage any issues through to resolution on behalf of the member, either on a single call or through comprehensive and timely follow-up. Meet the performance goals established for the position in the areas of compliance, efficiency, call quality, member satisfaction, first call resolution, punctuality, and attendance. Always maintain a professional level of service to members. Consistently support the Alliance's approach to Service Excellence by adhering to established department and company standards for all work-related functions. Interact positively with all Alliance departments. Perform other duties as assigned. MINIMUM QUALIFICATIONS: Bachelor's degree or equivalent experience preferred. High school diploma, GED required. MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE: Minimum one year of direct customer service Call center experience and managed care experience a plus. Minimum two years of experience in health services, managed care, hospital, or similar setting. SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE): Ability to prioritize and adapt to changing situations in a calm and professional manner. Excellent problem-solving skills. Excellent phone etiquette and ability to communicate clearly and concisely, both orally and in writing. Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member. Must be self-motivated and able to work with minimal supervision. Must be team-oriented and focused on achieving organizational goals. SALARY RANGE $22.00 - $33.01 PER HOUR The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled. #J-18808-Ljbffr
