Member Service Representative

WVU Medicine; United States; Remote; USD 36,000 - 48,000; Full time

Job summary

PHH Peak Health Holdings seeks a Membership Services Representative to handle inbound member calls, resolve issues, and support outbound outreach for issue resolution. This role emphasizes accurate information, effective communication, and adherence to policies while contributing to a seamless member experience.

Candidates should have a high school diploma or GED, 2+ years in a call center, and healthcare or insurance knowledge.

Qualifications

• High School diploma or GED required.
• Two years customer service in a call center.
• Associate degree in healthcare preferred.
• Two+ years in fast-paced call environment.
• Experience with medical insurance processes is a plus.

Responsibilities

• Verify member information and answer general questions.
• Respond to and resolve member inquiries for a seamless experience.
• Maintain open member communications and outreach as needed.
• Meet production and quality standards and manage work queues.
• Communicate with internal/external staff.
• Escalate issues to supervision when appropriate.
• Attend trainings and maintain documentation.
• Maintain timekeeping records.

Skills

Customer service

Call center experience

Healthcare knowledge

Communication skills

Problem solving

Education

High School diploma/GED

Associate Degree in healthcare

Tools

Epic Systems

Microsoft Office

Outlook

Excel

Job description

Welcome! We’re excited you’re considering an opportunity with us! Below, you’ll find other important information about this position.

This position will report to the Manager of Member and Provider Services, playing a unique and important role in our mission to change healthcare for the better.

Experience in the healthcare industry, critical thinking, and compassionate communication skills will help the organization build an effective and efficient Membership Services Team. The Membership Services Representative will take inbound calls from Peak Health members, answering questions ranging from general information to complex inquires on a wide range of issues.

The Membership Services Representative will work with management and peers on the Peak team to research and resolve member issues and questions. This role, in addition to taking inbound calls, will make outbound calls to members with issue resolution or to gather further information. Ability to think critically and communicate effectively while following organizational policies and procedures is a must.

MINIMUM QUALIFICATIONS** :**

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School diploma/GED

EXPERIENCE:

1. Two (2) years of customer service experience in a call center environment

PREFERRED QUALIFICATIONS** :**

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate Degree, or greater, in related healthcare field.

EXPERIENCE:

1. Two plus years’ experience in a fast-paced call environment with processing and/or customer service experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Verify member information while addressing general questions.

2. Responds to and resolves all issues/inquires to assure an efficient and seamless member experience.

3. Maintains open channels of member communications doing outreach as required.

4. Meets all production and quality standards, maintaining work queues according to department standards.

5. Effectively communicates with internal and external staff.

6. Elevates issues to next level of supervision, as appropriate.

7. Ensures accuracy of information gathered and shared on a member’s behalf.

8. Attends all required training classes, demonstrating proficiency and ability to learn.

9. Other duties as deemed appropriate by the Management Team.

10. Maintain accurate documents, including timekeeping records

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to sit for extended periods of time.

2. Ability to answer phone calls for extended periods of time.

3. Lifting 10-25 lbs.

4. Travel Requirement: 0%-25%

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)

2. Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access) Internet Explorer and EPIC

SKILLS AND ABILITIES:

1. Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.

2. Ability to take direction and to navigate through multiple systems simultaneously.

3. Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.

4. Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.

5. Familiarity with Medical insurance services process.

6. Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

7. Ability to work remotely – this includes reliability, self-motivation, focus & time management skills.

1. Ability to communicate clearly, concisely, and articulately while being an astute listener.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

PHH Peak Health Holdings

Cost Center:

2911 PHH Member Services