Member Services Representative

Watertown, MA 02472

Posted: 09/07/2018 Industry: Customer Service Representative Job Number: 3318630

JOB SUMMARY:

Under the general direction of the Call Center Supervisor, the Member Services Representative is responsible for providing accurate and thorough interpretation of benefits, claims processes, eligibility, and enrollment policies to members, employers, and internal customers. In addition, the Member Services Representative is responsible for resolution of complex customer inquiries, the facilitation of problem resolution, and meeting or exceeding customers expectations. The Member Services Representative presents a consistent and professional demeanor to all callers and internal customers and is expected to identify opportunities to improve customer service and efficiency. The Member Services Representative is expected to take responsibility for every interaction with a customer by providing outstanding service as a means to build customer loyalty, improve customer retention, and satisfy corporate customer service goals and objectives.



KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS

Receives and responds to a high volume of incoming telephone calls from members, prospective members, employers, and internal Tufts HP staff.

Efficiently and effectively processes member calls. This includes:

o Accesses the most appropriate source of information and proficiently resolving the member s concern.

o Accurately documents the complete encounter and maintains a professional and supportive attitude throughout the call.

o Asks probing questions and takes the opportunity to educate members to avoid unnecessary repeat calls.

o Investigates member complaints and performs front-line analysis and intervention when appropriate.

o Makes necessary outgoing phone calls to resolve member related inquiries.

Process all member correspondence as needed

Meet or exceed department established key performance indicators such as quality, adherence to schedule, productivity and/or others.

Interacts and forms contacts with other Tufts HP departments in order to resolve issues.

Provides available information upon request and escalates issues as appropriate.

Maintains confidentiality per HIPAA guidelines. 90%

Participates in initiatives and/or responds to requests for help to contribute to team and department success.

Assists in mentoring new staff as directed.



JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

EDUCATION: (Minimum educations & certifications required)

High School Diploma or equivalent required. Associates degree or equivalent work experience preferred.



EXPERIENCE: (Years of experience)

6-12 months of relevant experience preferred. Preferred customer service experience in health care, call center, retail, hospitality or corporate office. Knowledge of medical terminology is preferred.

SKILL REQUIREMENTS:

Technical Skills:

Must have strong computer and telephone multitasking skills

Must have the ability to navigate through multiple systems

Accuracy in data input and documentation

Proficiency with MS Windows

Proficient keyboard skills

Interpersonal Skills:

Excellent verbal and written communication skills are required

Demonstrates strong written (e.G., documents calls accurately and comprehensively) and verbal skills.

Employs active listening skills, demonstrates patience and empathy, and is able to handle difficult customers tactfully, courteously and professionally.

Strong organizational skills

Ability to research and respond to a high volume of telephone inquiries in a consistent and professional manner

Basic math, grammar, and spelling are required

Ability to work under pressure and with attention to changing priorities

Must be able to work cooperatively as part of a team

For certain positions, bilingual skills are preferred.

Ashley Dineen
Senior Client Relationship Manager

Ashley Dineen has been with The Panther Group since 2009 and has worked within many areas of the company including payroll, compliance, on-boarding, recruitment, and client management.

Ashley is a mother of two and enjoys spending time with family in her spare time.

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