Member Services Representative - Health New England : Job Details

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.)