Member Services Representative

SUMMARY:

The Member Services Representative provides superior customer service to members, providers, and employer groups.

ESSENTIAL FUNCTIONS:
Responds to inquiries from members, providers, and employer groups, providing superior product and benefit information for multiple HNE plans
Researches and resolves complex member inquiries via telephone, member mail, e-mail and fax
Educates members, employers and providers regarding benefits, policies, and procedures
Meets individual and departmental standards
Researches and resolves complex pharmacy issues utilizing the Reclaims system and the HNE Pharmacy Services Department
Performs New Member Outreach Calls
Processes member transactions, including but not limited to PCP changes, demographic changes, ID card requests and membership material requests
Collaborates with Enrollment, Claims, Health Services, Pharmacy, Legal, and Sales to ensure that member issues are appropriately resolved
Adheres to all regulatory requirements relating to member confidentiality, documentation, quality, and inquiry response time
MINIMUM REQUIREMENTS:

Associates degree and at least two years of customer service/call center experience within the managed care, insurance, or related call center industries or an equivalent combination of education and experience.

Demonstrated listening and customer service skills
Very good verbal and written communication skills
Multi-tasking and detail oriented skills
Problem resolution skills
Very good interpersonal and negotiation skills
Good organizational ability
PC knowledge - preferably with the Microsoft suite of products
WORKING CONDITIONS:

Works in a standard office-based environment

Irregular Schedule - Occasionally (1/4 - 2 1/2 hrs.)