Member Services Representative (8:00am-5:00pm)

US-LA-Metairie
Job ID
3513
Category
Professional - All

Overview

Position Purpose 

To create an exceptional experience for our members, providers, and internal/external  customers while assisting them with inquiries, issues and concerns that are presented.  With the objective of providing quality and consistent service to Medicare and Medicaid members resulting in increased member satisfaction, retention and access to care. 

 

Scope of Position 

Responsible for handling all incoming telephone calls, emails, correspondence and internal contacts regarding benefits, supplemental  benefits such as transportation  request, claim status, primary care physician changes, enrollment/eligibility, claims, grievances and appeals in accordance with the departmental goals, inclusive of appropriate documentation, policies and procedures established by Peoples Health. The Member Services Representative will perform some general administrative duties such as, but not limited to, covering the front desk functions, handling the mail, and faxing documents. Participate in and contribute to special projects as needed and all other duties as assigned.

Responsibilities

 Principle Responsibilities

  • The Member Services Representative  handles inquiries, concerns, complaints, grievances and appeals in a professional manner by listening to the member and showing respect. When appropriate, the Representative  I takes action to resolve complaints to ensure member retention and satisfaction by following department guidelines or contacts immediate supervisor for intervention.
  • Educates members, customers (internal/external)  while effectively  promoting Peoples Health products, services, and policies on the telephone as well as face-to-face communication.
  • Acts in accordance with Peoples Health vision and values.  Participates and supports development  programs, active in staff meetings, and performs company educational offerings as well as demonstrating  the willingness to work as a team member when needed for additional tasks to ensure excellent service.
  • Ensures that supplies are sufficient to perform their duties, maintains equipment in proper place after usage and maintains workspace in an orderly fashion.
  • Acts as an efficient liaison for the member and effectively documents 100% of their communication  in the service module achieving a clear link between subject line, category, sub-category and free text.
  • As needed, handles requests for transportation to participating providers and return trip requests. Properly utilizes the transportation database. Generates denial letters when needed. When requested, prepares daily schedules for vendors and reporting requirements.
  • The Representative must become familiar with standard health-care concepts, practices, and procedures as they relate to claims adjudication and managed care.
  • Complete special assignments in an accurate and efficient manner with little intervention from management.
  • The Representative must complete Quality Workshop training and all Eduneering Courses timely

 

Qualifications

 Core Competencies

  • Professionalism
  • Motivation to succeed
  • Ability to work effectively and cooperatively with all staff
  • Ability to diffuse and resolve difficult customer situations
  • Projection of a positive, willing attitude along with team building skills
  • Commitment to providing quality interactions and exceptional service to our members, providers and customers.
  • Exceptional oral and written communication  skills, including having a professional telephone presence
  • Attention to detail and accuracy
  • Ability to clearly and concisely document calls or interactions
  • Ability to type a minimum of35 words per minute (10 key touch), while handling a call

 

Experience/Education 

  • High school diploma or GED required.
  • Business-related college coursework preferred
  • Prior experience in a call center environment or related customer service field highly preferred
  • Prior experience working in a health care environment also highly preferred
  • Computer navigation skills with experience in a Windows environment 
    • Required skills:
      • Excel - enter information, save files, navigate through worksheet
      • Word - Create documents
      • Outlook- Organizing email
      • Internet- Utilize web-based internal applications
    • Preferred skills:
      • Access - Data entry into an existing data base, run standard reports
  • Amisys experience a plus
  • Bilingual (Spanish) a plus

 

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