Member Services Agent - REMOTE

Southern Scripts; United States; Remote; USD 21,000 - 28,000; Full time

Job summary

Southern Scripts is seeking a Remote Member Services Agent to provide excellent service to internal and external customers, leveraging knowledge of Rx claims processing and HIPAA obligations. You will document inquiries, follow up on issues, and coordinate with departments to resolve problems.

The role emphasizes strong computer skills, careful information handling, and effective communication with supervisors and teammates to meet quality standards and customer satisfaction.

Qualifications

• Experience delivering customer service via phone and email.
• Ability to follow HIPAA guidelines.
• Strong communication and time-management skills.
• Familiarity with using computers and software for data entry.
• Ability to handle inquiries and resolve issues.

Responsibilities

• Provide effective customer service to internal and external customers.
• Refer unresolved grievances to appropriate departments.
• Review Rx insurance policy terms to determine coverage.
• Document customer interactions and actions taken.
• Follow-up to ensure problems are resolved.
• Adhere to HIPAA training requirements.

Skills

Interacting with Computers

Customer Service

Communication

Time Management

Problem Solving

Teamwork

Education

High School or equivalent

Job description

Member Services Agent - REMOTE

Role and Responsibilities

The member services agent is responsible for providing effective customer service for all internal and external customers by using excellent, in-depth knowledge of company products and programs as well as communicating effectively with team members within the customer service department.

Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. Confer with customers by telephone to provide information about Rx claims processing.

Keep detailed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.

Follow-up to ensure that appropriate changes were made to resolve customers' problems.

Refer unresolved customer grievances to designated departments for further investigation.

Review Rx insurance policy terms to determine whether a claim is covered for employer group.

Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.

Resolve customers' service or billing complaints.

Obtain and examine all relevant information to assess validity of complaints and to determine possible causes.

Abide by all obligations under HIPAA related to Protected Health Information (PHI).

If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.

Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.

Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Required Skills and Competencies

• Interacting with Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
• Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
• Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
• Communicating with Persons Outside Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
• Processing Information — Compiling, coding, categorizing, calculating tabulating, auditing, or verifying information or data.
• Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
• Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.
• Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work.
• Performing Administrative Activities — Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
• Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
• Customer and Client Focus.
• Problem Solving and Analysis.
• Time Management.
• Communication Proficiency.
• Teamwork Orientation.
• Technical Capacity.
• Multitasking

Position Type and Expected Hours of Work

This is a temporary, hourly position. Days and hours of work vary on shift assigned. The Call Center hours of operation are Monday – Friday 6a – 10p, Saturday 8a – 10p, and Sunday 8a-10p. On-Call responsibilities are on a rotation basis.

Travel

No travel is expected.

Qualifications and Education Requirements

• High School or equivalent.
• Customer service experience.
• Computer experience.