MEMBER SERVICE REPRESENTATIVE

Job Overview:

This position is to serve as the point of contact for both provider and members’ questions and/or concerns regarding benefits, eligibility, referrals, claims, and any other aspect of plan benefits/services.

Essential Functions:

• Answer calls from members, dependents, and providers of service

• Understand and effectively explain all aspects of the Health and Welfare Plan pertaining to eligibility, claim status, and benefit details

• Respond appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and/or written inquiries concerning benefits, eligibility, referrals, claims, and all other issues following departmental policies and procedures

• Provide follow-up with members by clarifying the issue, determining the cause, and explaining the solution

• Escalate member issues to the Escalations Coordinator, Member Advocate, or Management when appropriate

• Communicate professionally with members, coworkers, and outside vendors for quick resolutions

• Accurate data entry of time sensitive materials

• Be present and actively participate in Health and Welfare events

• Other duties as assigned

Education and Experience:

• High School diploma or equivalent

• 3 – 5 years of prior customer service experience required

Specialized Skills/Technical Knowledge:

• Knowledge of medical terminology is required

• Knowledge of Salesforce or other CRM tools is a plus, but not required

• Strong communication

• Must be detail oriented

• Ability to handle multiple tasks in a fast-paced setting

• Ability to work independently and as part of a team

• Ability to work with other departments as necessary

• Maintain a pleasant and professional demeanor on the phone and face to face

• Proficient in Microsoft Office

• Be able to work Saturday overtime

Wage: $31.15 per hour

Hours: Monday through Friday 8am to 5pm (scheduled overtime Saturday 8am to noon) (Health and Welfare events vary and could include Saturday and Sunday)