Medicare Advantage Customer Service Representative

2 weeks ago


Columbus, Ohio, United States SIHO Insurance Services, Inc. Full time
Job Description

Job Title: Medicare Advantage Member Services Representative

Reports To: Supervisor of Medicare Advantage Customer Service

SIHO Insurance Services, Inc. is seeking a highly skilled and compassionate Medicare Advantage Member Services Representative to join our team. As a key member of our customer service team, you will play a vital role in delivering exceptional service to our members and their providers.

Key Responsibilities:

  • Assist members with navigating their healthcare needs by explaining benefits, resolving claim concerns, and finding nearby healthcare providers.
  • Comply with regulatory requirements while addressing customer needs, including complex benefit questions.
  • Record details of inquiries, comments, complaints, and transactions.
  • Escalate unresolved and pending customer grievances.
  • Support teammates as business needs require to ensure the organization is meeting the needs of our members and providers.
  • Strive for first call resolution while demonstrating SIHO's dedication to proactively resolving member questions and concerns.
  • Work with partners in other departments or with healthcare providers to resolve customer concerns.
  • Perform other relevant duties deemed necessary to achieve department and company-wide goals.

Requirements:

  • Possess a passion for customer service and a strong desire to help others.
  • Excellent communication (oral and written) and strong listening skills.
  • General knowledge and understanding of health insurance.
  • Knowledge of Medicare Advantage is preferred but not required.
  • Ability to maintain attendance to support required quality and quantity of work.
  • Professional appearance and presence.
  • Commitment to support and maintain confidentiality in conformance to HIPAA guidelines.

Preferred Qualifications:

  • High School Diploma and 2 years of customer service experience.
  • Working experience of Microsoft Office or other comparable software.

Work Schedule:

Due to the nature of our business, this position requires weekend work during certain times of the year. The busy season runs from October 1st to March 31st, during which our team needs to be available 7 days a week from 8am to 9pm. Schedules are mapped out a month in advance, with employee preference taken into account. Shift times include 8am-5pm, 9am-6pm, or 12pm-9pm (remote), and possibly 10am-7pm (dependent on call center needs). Weekend shifts are required, at least 2 weekends a month during busy season. Weekend shifts are REMOTE 12pm-9pm or 10am-7pm.

Off season runs from April 1st to September 30th, during which the schedule is Monday-Friday 8am-9pm with options for 8am-5pm, 9am-6pm, or 12pm-9pm (remote). Employees must be available to work 9am-6pm or 12pm-9pm at least once a week.

SIHO Insurance Services, Inc. is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive work environment that values diversity, equity, and inclusion.



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