Member Services Representative addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls, or written questions. Being a Member Services Representative provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Member Services Representative works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Member Services Representative typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Employees at a franchise location are employed by the Franchisee and are not employees of PFHQ (the Franchisor). PFHQ neither dictates nor controls labor or employment matters for franchisees or their employees, and does not retain any reserved authority to control the terms and conditions of employment for franchisees or their employees. Each franchisee is responsible for ensuring compliance with local, state and federal law.