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    Member Services Representative - Springfield, United States - Health New England

    Health New England
    Health New England Springfield, United States

    1 week ago

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    Description

    Job Description

    Job Description

    SUMMARY: The Member Services Representative provides superior customer service to members, providers, and employer groups.

    ESSENTIAL FUNCTIONS:

    • 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

    MINIMUM REQUIREMENTS:

    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.

    • 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

    WORKING CONDITIONS: Works in a standard office-based environment

    • Irregular Schedule - Occasionally (1/4 - 2 1/2 hrs.)
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