Member Services Specialist

Job Responsibilities:

• Meets expectations of the applicable Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Respond to inbound calls, emails, and member chat messages regarding healthcare-related questions and concerns.
• Adhere to established service level agreements (SLAs) and quality standards to consistently deliver excellent customer service about insurance benefits, claims, coverage, and other related inquiries. Assist members in navigating the healthcare system and understanding their rights and responsibilities.
• Investigate and resolve member complaints, issues, and escalations promptly and satisfactorily. Document all customer interactions and issue resolutions accurately and comprehensively in the CRM system.
• Collaborate with internal departments to facilitate issue resolution and ensure a seamless customer experience.
• Explain insurance plans, policies, and procedures to members, ensuring they understand their benefits and coverage clearly.
• Provide guidance on accessing healthcare services, locating in-network providers, and understanding pre-authorization requirements.
• Continuously enhance product knowledge and stay updated on industry trends and changes.
• Identify process improvement opportunities and provide recommendations to enhance the overall member experience.
• Proactively contribute to the development and implementation of customer service best practices.
• Collaborate with team members and management to improve operational efficiency and streamline workflows and customer satisfaction.
• Support USFHP, HIX, and NCHD LOB as needed. Participate in training sessions and professional development activities to enhance knowledge and skills.

Skills:

• Customer Service,
• member service,
• insurance,
• claims,
• healthcare

Education/Experience:

• A High School diploma or equivalent is required. 0 -2 years of customer service experience is preferred. Work Type: Full Time