- 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
- 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
- Irregular Schedule - Occasionally (1/4 - 2 1/2 hrs.)
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Member Services Representative - Springfield, United States - Health New England
Description
SUMMARY: The Member Services Representative provides superior customer service to members, providers, and employer groups.ESSENTIAL FUNCTIONS:
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.