Member Services Representative

Siho Insurance Group; Columbus (IN); Hybrid; USD 32,000 - 42,000; Full time

Job summary

SIHO Insurance Group in Columbus, Indiana is seeking a friendly Member Services Representative to assist members and providers. The role focuses on handling inquiries by phone and written channels, explaining benefits, resolving issues, and supporting colleagues while maintaining HIPAA compliance.

This is a non-exempt, on-site position reporting to the Manager of Member Services, offering a collaborative environment with opportunities to grow in healthcare customer service.

Qualifications

• High School Diploma required and 2 years of customer service experience.
• Healthcare experience is a plus but not required.
• Strong communication and active listening skills are essential.

Responsibilities

• Assist members with navigating healthcare benefits, resolving questions, and guiding them to appropriate providers.
• Explain benefits and resolve claim concerns over the phone and in written form.
• Record inquiries, comments, complaints, and transactions accurately.
• Escalate unresolved issues and patient grievances as needed to ensure resolution.

Skills

Customer service

Communication

Empathy

Problem solving

HIPAA knowledge

Education

High School Diploma

Tools

Microsoft Office

Job description

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
• CommunicatorPatient
• 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
• Professional appearance and presence
• Commitment to support and maintain confidentiality in conformance to HIPAA guidelines

Required Education:

• High School Diploma and 2 years of Customer service experience
• Working experience of Microsoft Office or other comparable software

*All positions are subject to change based on the needs of the business