Job Type: Full-time
Pay: $20.00 – $21.00 per hour
Job purpose ***This is an in-office position***
The Member Services Representative is responsible for assisting Members, Providers, and Health Plan staff by providing accurate answers to questions regarding the Health Plan in a timely and courteous manner. The Member Care Professional may also facilitate the process for Health-Education related activities and other Health Plan functions and events.
Duties and responsibilities
- Answers Member/Provider telephone inquiries via ACD phone system.
- Always maintains professional and courteous telephone etiquette, based on Sonder’s core values.
- Logs all calls in Salesforce (CRM platform).
- Provides status on claims, prior authorizations, and eligibility to Members and Providers.
- Facilitate phone conversations with the Member and/or Provider.
- Assist Members with but not limited to (benefits, PCP lookup, appointment setting, scheduling transportation, and documenting Grievance and/or appeals).
- Follow up on resolution of inquiries and communicating to all parties involved, in a timely and professional manner.
- Attends Customer Service & staff training, as required.
- Assists and supports other Member Services Department staff, as needed.
- Maintains and keeps in total confidentiality, all files, documents, and records that pertain to the operation of business of the Health Plan.
- All other job-related duties as it relates to the job function or as delegated by the management team.
Education/ Experience/Qualifications
Required
- Three-five years minimum Member/Provider service experience in a healthcare environment.
- Excellent verbal and written communication skills.
- Excellent organization skills with ability to handle multiple tasks and prioritize work in a fast-paced environment.
- Three – five-year minimum ACD or comparable multi-line call center experience.
- Computer literate with high proficiency in Microsoft applications.
Preferred
- The knowledge, skills and abilities typically acquired through the completion of an associate’s degree.
- Extensive Medicare experience.
- Familiar with start-up companies.
- Familiar with CMS regulations.
- Bilingual (English/Spanish).