Member Services Representative

SIHO Insurance Services; Columbus (IN); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Job summary

SIHO Insurance Services is seeking a Member Services Representative in Columbus, IN. The role focuses on responding to member and provider inquiries, primarily by phone, with some written communication and walk-in assistance.

This non-exempt, on-site position reports to the Manager of Member Services. Responsibilities include guiding members through benefits, resolving claim concerns, and coordinating with providers to resolve issues.

Qualifications

• Passion for customer service.
• Excellent oral and written communication; strong listening skills.
• General knowledge of health insurance.
• Ability to maintain reliable attendance to meet quality and quantity targets.

Responsibilities

• Respond to member and provider inquiries via telephone and written channels.
• Assist members with navigating benefits and resolving claim concerns.
• Locate doctors or providers and advocate for members’ healthcare needs.
• Record inquiry details, comments, complaints, and transactions.
• Escalate unresolved or pending customer grievances.
• Collaborate with other departments and providers to resolve issues.
• Aim for first-call resolution and proactive problem solving.
• Perform other duties to support team and company goals.

Skills

Customer service

Communication skills

Active listening

Empathy

Emotional intelligence

Attendance

Job description

Job Title: Member Services Representative
Reports To: Manager, Member Services
Locations: Columbus, IN
**Not open to remote candidates at this time

SIHO’s Member Services Representatives assist in creating an excellent experience for SIHO’s members and their providers. The primary responsibility of this position is to respond to member’s and providers inquiries. This position mainly responds to telephonic inquiries but may also be responsible for responding to written inquiries and assisting walk-in members. This is a non-exempt position reporting to the Manager of Member Services.

Brief Description of Duties:

• Assist members with navigating their healthcare needs by explaining benefits, solving claim concerns, finding a doctor nearby or being their healthcare advocate
• Comply with regulatory requirements while addressing customer needs which may include complex benefit questions.
• Record details of inquiries, comments, complaints, and transactions.
• Escalate unresolved and pending customer grievances.
• Support teammates as business needs require to ensure the organization is meeting the needs of our members and providers
• Strive for first call resolution while demonstrating SIHO’s dedication to proactively work to resolve members questions and concerns.
• Work with partners in other departments, or to Doctors’ offices to help resolve a customer concern.
• Support your teammates as business needs require to ensure we are meeting the needs of our customers.
• Performs other relevant duties deemed necessary to achieve department and company-wide goals.

Traits we are looking for:

• Trustworthy
• Empathic
• Proactive
• Compassionate
• Good Listener
• Problem Solver
• Communicator
• Patient
• Personable & Collaborative

Minimum Skills Requirement:

• Possess a passion for customer service
• Excellent communications (oral and written) and strong listening skills
• Experience in healthcare is preferred, but not required
• General knowledge and understanding of health insurance
• This job calls for strong emotional intelligence to proactively provide solutions, ensuring the member's health and safety
• Ability to maintain attendance to support required quality and quantity of work