Member Services Representative

Description

Hybrid role

Job Summary:

The Member Service Representative is the face of Client Select Health Plan and directly impacts the member’s service experience by how well customer service inquiries and problems via telephone, Internet or written correspondences are handled. The MSR always maintains a positive caller experience.

Job Responsibilities:

• Documents and tracks contact with members, providers and plan sponsors; ensuring calls and rework are distributed to the appropriate staff.
• Guides the member through their member plan of benefits, MCSHP policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
• Creates an emotional connection with our members by understanding and engaging the member to the fullest to advocate for our member’s best health.
• Takes accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
• Anticipates member’s needs. Provides the customer with related information to answer the unasked questions, (e.g. additional plan details, benefit plan details, member self-service tools, etc.)
• Explains member’s right and responsibilities in accordance with the contract and regulatory requirements.
• Support all Member and Provider Services phone queues as required. (Medical Management, Claims, Provider Services)
• Process member grievances and appeals received by telephone, fax, email and through Client Select’s member portal.

Skills:    

Required Skills & Experience:

• Minimum of two (2) years of experience in a transaction-based environment such as a call center or similar environment.
• Basic computer skills, including general knowledge of MS Word and Excel applications, type minimum of 45 WPM.

Required Education:

• High school graduate or equivalent.

Required Certifications & Licensure:

• Specialty coding certification.