Member Services Representative

Health New England; Springfield (MA); On-site; USD 40,000 - 60,000; Full time

Job summary

An established industry player is seeking a dedicated Member Services Representative to deliver exceptional customer service. In this entry-level role, you will engage with members, providers, and employer groups, providing vital information and resolving inquiries. Your ability to multitask and communicate effectively will be key in ensuring member satisfaction. This role offers a unique opportunity to grow within the insurance sector while contributing to a team that values collaboration and quality service. Join a company that prioritizes its members and fosters a supportive work environment.

Qualifications

• Associates degree and 2 years of customer service experience required.
• Demonstrated listening and communication skills are essential.

Responsibilities

• Respond to inquiries and provide product information for multiple plans.
• Research and resolve complex member inquiries via various channels.

Skills

Customer Service Skills

Problem Resolution Skills

Verbal Communication

Written Communication

Multi-tasking

Detail Oriented

Interpersonal Skills

Negotiation Skills

Organizational Skills

Education

Associates Degree

Tools

Microsoft Suite

Job description

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SUMMARY: The Member Services Representative provides superior customer service to members, providers, and employer groups.

Essential Functions

• Responds to inquiries from members, providers, and employer groups, providing superior product and benefit information for multiple HNE plans
• Researches and resolves complex member inquiries via telephone, member mail, e-mail and fax
• Educates members, employers and providers regarding benefits, policies, and procedures
• Meets individual and departmental standards
• Researches and resolves complex pharmacy issues utilizing the Reclaims system and the HNE Pharmacy Services Department
• Performs New Member Outreach Calls
• Processes member transactions, including but not limited to PCP changes, demographic changes, ID card requests and membership material requests
• Collaborates with Enrollment, Claims, Health Services, Pharmacy, Legal, and Sales to ensure that member issues are appropriately resolved
• Adheres to all regulatory requirements relating to member confidentiality, documentation, quality, and inquiry response time
  
  

Minimum Requirements

Associates degree and at least two years of customer service/call center experience within the managed care, insurance, or related call center industries or an equivalent combination of education and experience.

• Demonstrated listening and customer service skills
• Very good verbal and written communication skills
• Multi-tasking and detail oriented skills
• Problem resolution skills
• Very good interpersonal and negotiation skills
• Good organizational ability
• PC knowledge - preferably with the Microsoft suite of products
  
  

WORKING CONDITIONS: Works in a standard office-based environment

• Irregular Schedule - Occasionally (1/4 - 2 1/2 hrs.)

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Insurance

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