Job Description
Position Title
Member Services Representative I
Reports To
Supervisor, Member Services
Department
Operations
Position Summary
Entry level, fully trained Member Services Representative (MSR I) to respond to member/provider inquires, whether of a substantive nature, a procedural nature, or both. The position provides customer service to all inbound calls as well as making outbound/outreach calls when necessary. All calls routed through an Automatic Call Distribution (ACD) system, from members and/or providers on a variety of topics to educate them on benefit issues, claims inquiries and collect feedback regarding various campaign initiatives for the company.
Essential Duties and Responsibilities
- Complies with HIPAA/PHI regulations in all interactions with internal (representative from other departments) as well as external (members/providers)
- Handles and/or exceeds average of 45 calls a day, while meeting the service standards.
- Ability to meet the minimum QA audit scoring criteria.
- Attends to the members/providers inbound calls to assist with any appropriate information about benefits, provider and customer service issues.
- Documents details of all calls in the appropriate system and routes issues to appropriate department for follow up, when/if necessary.
- Follows up on pending unresolved issues.
- Provides expertise and customer service support to internal customers.
- Documents complaints and grievances in the appropriate systems and forwards to the appropriate entities.
- Meets and maintains tardiness and attendance standards set by department policy.
- Performs other duties and activities as deemed necessary.
- Performs other duties as assigned.
Education, Experience and Qualifications
- 6 months Customer Service or ACD Call Center Experience preferred in a health insurance, medical or equivalent field.
- Minimum of 1 year of College experience preferred or equivalent directly related experience.
Knowledge, Skills and Abilities
- Excellent interpersonal skills.
- Professional organizational, oral and written communication skills. · Ability to listen, document and track problems within the appropriate systems, simultaneously while on calls.
- Ability to respond in difficult situations on the telephone calls. Maintain flexibility and a “can do” attitude supporting department goals and objectives.
- Able to commit to overtime as needed and/or shift changes.
- Ability to type a minimum of 35 wpm.
- Successfully complete in-house training program (90% or better on final test).
Work Remotely
- Temporarily due to COVID-19
Physical Requirements
Computer Skills
- Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word.
Affirmative Action/EEO statement
The Company provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Other duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Exhibit A
Checklist: Job Analysis/Job Description Physical Activities
Physical Activities
Ascending or descending ladders, stairs, scaffolding, ramps, poles and the like.
☒ Never ☐ Occasionally ☐ Constantly
Moving self in different positions to accomplish tasks in various environments including tight and confined spaces.
☒ Never ☐ Occasionally ☐ Constantly
Remaining in a stationary position, often standing or sitting for prolonged periods.
☐ Never ☐ Occasionally ☒ Constantly
Moving about to accomplish tasks or moving from one worksite to another.
☒ Never ☐ Occasionally ☐ Constantly
Adjusting or moving objects up to 15 pounds in all directions.
☐ Never ☒ Occasionally ☐ Constantly
Communicating with others to exchange information.
☐ Never ☐ Occasionally ☒ Constantly
Repeating motions that may include the wrists, hands and/or fingers.
☐ Never ☐ Occasionally ☒ Constantly
Operating machinery and/or power tools.
☒ Never ☐ Occasionally ☐ Constantly
Operating motor vehicles or heavy equipment.
☒ Never ☐ Occasionally ☐ Constantly
Assessing the accuracy, neatness and thoroughness of the work assigned.
☐ Never ☐ Occasionally ☒ Constantly
Environmental Conditions
Low temperatures.
☒ Never ☐ Occasionally ☐ Constantly
High temperatures.
☒ Never ☐ Occasionally ☐ Constantly
Outdoor elements such as precipitation and wind.
☒ Never ☐ Occasionally ☐ Constantly
Noisy environments.
☐ Never ☒ Occasionally ☐ Constantly
Hazardous conditions.
☒ Never ☐ Occasionally ☐ Constantly
Poor ventilation.
☒ Never ☐ Occasionally ☐ Constantly
Small and/or enclosed spaces.
☒ Never ☐ Occasionally ☐ Constantly
No adverse environmental conditions expected.
☒ Never ☐ Occasionally ☐ Constantly
Physical Demands
Sedentary work that primarily involves sitting/standing.
☐ Never ☐ Occasionally ☒ Constantly
Light work that includes moving objects up to 20 pounds.
☐ Never ☒ Occasionally ☐ Constantly
Medium work that includes moving objects up to 50 pounds.
☒ Never ☐ Occasionally ☐ Constantly
Heavy work that includes moving objects up to 100 pounds or more.
☒ Never ☐ Occasionally ☐ Constantly
Job Types: Full-time, Part-time
Pay: From $20.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Shift:
Weekly day range:
Work setting:
Work Location: Remote