- Answer inquiries regarding eligibility and confirmation of benefits for coverage of proposed services.
- Answer inquiries regarding the status of claims payment for all Everence health products.
- Research and assist in resolving all issues coming into the call center.
- Work with the cancelation of a policy and strive to retain membership.
- Provide coverage options for Medicare Supplement products including pricing.
- Maintain an understanding of Everence third-party administration products and services; Medicare and Medicare Supplement plans; Medicaid; corporate policies, and product-specific policies; procedures and business rules for the above-named products.
- Provide appropriate written correspondence to members and providers.
- Document all customer service contacts.
- Perform other duties and assignments as requested by the Health Member Services Manager.
- Ability to obtain and maintain a license in Health insurance
- Excellent verbal and written interpersonal and communication skills including a high level of listening skills
- Customer-oriented with the ability to adapt and respond to different types of customers with sensitivity
- Demonstrates initiative
- Ability to make quick and appropriate decisions despite interruptions
- Flexibility with changing work patterns and/or varying workloads
- Excel at problem-solving
- Attention to detail with the ability to multi-task and prioritize while managing time effectively
- Proficient computer skills and solid knowledge of Microsoft Office programs
- Ability to develop and maintain a strong sense of teamwork
- Medical and insurance background desirable
- Fluency in Spanish preferred
- Must be able to maintain call center hours (currently weekly 8 am to 5 pm)
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Health Member Services Specialist - San Francisco, United States - Everence
Description
POSITION SUMMARYAnswer inquiries, resolve issues, and handle customer (internal and external) concerns while maintaining a professional image through superb telephone etiquette and excellent customer service. Serve as a key member of a cross-functional team responsible for incoming and outgoing customer services for members, consultants, and others as related to Everence health products.
RESPONSIBILITIES AND DUTIES
QUALIFICATIONS
Experience:
High school graduate
Skills and Abilities:
SUPERVISORY RESPONSIBILITIES: None
SCHEDULE: Full-time
