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About the Role

The Member Services Representative responds to member and provider inquiries, researches and resolves issues efficiently and empathetically, and applies appropriate triage and escalation protocols. This role requires excellent attendance, punctuality, and a results-driven approach.

Responsibilities

• Compliance with call center performance standards.
• Answer incoming member/provider calls in accordance with established standards.
• Consistently meet or exceed regulatory, contractual and accreditation call center standards.
• Document and track 100% of inquiries received through the Plan's call center using the Plan's call tracking system.
• Ensure that all data is entered accurately and timely.
• Receive, respond, research and resolve all customer inquiries (telephone, walk-in, and written) including but not limited to plan benefits, policies, procedures, eligibility, referrals, authorizations, pharmacy override inquiries and claims.
• Educate members/providers at each encounter on benefits and health plan navigation.
• Provide accurate and effective consultation on all aspects of the health plan.
• Promote customer satisfaction by ensuring that all customer inquiries are resolved in a timely and efficient manner.
• Proactively identify areas for operational and process improvements related to customer satisfaction.
• Assist with the maintenance of member/provider data by verifying the accuracy of such data with each member encounter.
• Process updates and changes to member data including but not limited to PCP changes and demographic changes.
• Support Plan departments through member service call and issues resolution.
• Provide internal support to external member services consultants.
• Research and resolve customer inquiries in a timely and efficient manner.
• Take ownership for issues.
• Follow appropriate triage, resolution and escalation protocols.
• Confirm that issues are resolved according to customer's satisfaction.
• Be aware of the potential for fraud and how to report suspected fraudulent activity.
• Perform other responsibilities as assigned.

Requirements

• 1 year Customer Service or call center experience.
• Must have the ability to provide a high-speed internet for a home office.

Skills

• Microsoft Office skills - Word, Outlook, PowerPoint, Excel, Access.
• Experience with standard office equipment - copier, scanner, fax, multiline phone, calculator.
• Excellent verbal and written communication skills.
• Ability to listen well.
• Problem solving capabilities while dealing with conflict, hostility, multiple projects and time constraints.
• Ability to take responsibility and ownership for actions and outcomes despite any obstacles and conflicts.
• Decision making.
• Ability to work with others toward team goals.
• Maintain a positive outlook.
• Dependability - available and dependable for work shift.
• Able to file/retrieve documents using an alphabetical filing system.
• Fundamental mathematical skills (addition, subtraction, division, calculation of percentages).

Location

• Remote
• In office

Work Type

• TEMP to PERM
• Remote
• In office

Experience Level

• 1 year experience

Education Level

• High School Diploma or Equivalent
• Associates' Degree Preferred

Salary/Compensations

• TEMP Hourly Rate is $27.47
• PERM Hourly Rate $30.22

Benefits

• Medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services.
• Vision coverage through UnitedHealthcare Vision.
• Dental benefits through MetLife.
• Basic life and disability insurance are automatically provided at no cost.
• Commuter benefits.
• Tuition reimbursement.
• 401(k) retirement plan with an immediate employer match that is fully vested from day one.
• Generous time off package, which includes vacation, 10 paid holidays, and 3 personal days.
• Comprehensive Employee Assistance Program.
• Exclusive discounts through Working Advantage.

About the Company

• SVCMC, Inc. provides a robust benefits package.

Equal Opportunity

• SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.