Member Services Representative, Sr. addresses more complex health plan or HMO 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 and written requests. Being a Member Services Representative, Sr. provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative, Sr. requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Member Services Representative, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Member Services Representative, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
Position Overview: The Member Service Representative plays a vital role in delivering superior customer service and building strong relationships with our members. This position serves as the primary point of contact for members, providing assistance with account inquiries, transactions, and financial services. The ideal candidate will have a passion for helping others, excellent communication skills, and a commitment to exceeding customer expectations.
Key Responsibilities:
Member Assistance:
Problem Resolution:
Financial Services:
Transaction Processing:
Customer Relationship Management:
Qualifications: