Hybrid- Member Service Representatives (3rd Shift)

Position Summary :

The Member Services Representative is primarily responsible for providing information and referral services in responding to and resolving customer requests and issues.

The nature of this position requires a particular emphasis on reliability and flexibility in shift schedules in order to ensure that the service level requirements of our clientele are consistently achieved and proficiency in delivering exceptional customer service.

The MSR is required to be knowledgeable of multiple programs in order to provide services for 2-4 programs simultaneously, and to resolve more complex issues and inquiries.

Primary Responsibilities :

• In order to ensure that client service level requirements are consistently achieved, attend work reliably and adhere to scheduled shift times including lunch and break schedules
• Demonstrate proficiency in utilizing multiple systems and / or databases to evaluate, analyze and resolve customer issues and utilize sound judgment in escalation of issues
• Resolve inbound and outbound contacts in accordance with established program policies, procedures, and standards
• Resolve escalated / complex customer issues by utilizing analytical and researching skills; as necessary, directly coordinate with insurers, payers, providers, clients and advocacy groups in order to completely resolve an issue
• Demonstrate consistent and professional customer service skills : active listening, ability to engage the customer, appropriate utilization of resources, clear written and verbal communication
• Provide feedback and suggestions regarding policies and procedures used within the Contact Center in the interest of providing exceptional service
• Perform analytical functions, including but not limited to : reconciliation of claims and billing related activity
• Exceed minimum productivity standards for each task assigned
• Document all contacts in accordance with established program policies, procedures, and standards
• Provide on-the-job training and support for other staff members as directed
• Actively participate in quality control / quality improvement initiatives
• Utilize subject matter expertise to contribute to new business development initiatives and projects (e.g. implementation, testing, documentation and training materials)
• Attend and participate in meetings and training as directed
• Maintain the confidentiality of all business documents and correspondence according to HIPAA, corporate, and program guidelines
• Comply with established departmental policies, procedures and objectives
• Comply with all health and safety regulations and requirements Position Qualifications :
• Associates degree or comparable advanced education (college level coursework, certification courses, etc.) or comparable additional work experience
• Must have at least 3 years of information and referral experience with at least 2 of those years being in a healthcare related call center environment (additional education and / or certifications may be considered in place of experience);
• Must read, speak and write English fluently
• Bi-lingual proficiency preferred (Must read, speak and write Spanish fluently);
• Must be available to accommodate a variable work schedule rotation which includes; morning, mid-day, evenings, overnight, weekends, and holiday assignments;
• Must be flexible regarding hours scheduled;
• Must have flexibility to work various shifts Sunday - Saturday
• Physical ability to stand and repetitively bend down and reach up for extended periods of time (e.g. for file room projects);
• Ability to effectively provide service to multiple clients simultaneously (e.g. handle a call queue of multiple lines) Required Skills :
• Strong customer service skills including the ability to relate well to diverse populations and to represent the organization professionally
• Ability to mentor staff members on subject matter and customer service skills
• Sound judgment and discretion required
• Ability to communicate clearly and effectively verbally and in writing
• Strong time management and organizational skills necessary to prioritize multiple projects, requirements and deadlines
• Ability to thoroughly comprehend the subject matter and systems used in order to handle a wide variety of inquiries from callers in a timely and accurate manner
• Analytical and problem-solving abilities to research multiple internal and external information sources and utilize information to resolve issues
• Accurate typing / data entry and information tracking skills at a minimum proficiency of 40 words per minute
• Computer Literacy including basic proficiency with Internet Browsers, Microsoft Outlook, Word, and Excel

Last updated : 2024-05-23