Remote Member Experience Specialist

SHPCA SCAN Health Plan; Nevada (IA); Hybrid; USD 57,308,160 - 61,606,272; Full time

Benefits offered by this job

Annual bonus program

Wellness program

PTO and holidays

Job summary

SCAN Health Plan is hiring for a remote Member Service Rep to serve members with benefits, eligibility, referrals, and claims questions. You’ll educate members and caregivers about plan options, explain benefits clearly, and follow up to resolve issues in a timely, compliant manner.

Ideal candidates have 1–2 years in call center or healthcare-related customer service, strong communication, data-entry skills, and the ability to handle high call volumes professionally.

Qualifications

• 1-2 years call center or related customer service experience, required.
• 1-2 years of Medicare benefits experience preferred.
• Experience in the healthcare, insurance or pharmacy industry highly desirable.
• Ability to maintain calm demeanor at all times, including during highly charged situations.
• Data entry and general computer skills (word processing, e-mail) required.
• Effective communication (oral and written) skills.
• Professional/pleasant telephone manner required.
• Ability to handle large call volume, while providing excellent customer service at all times required.
• Demonstrated efficiency/effectiveness in an environment with a high call volume.

Responsibilities

• The job Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services.
• Ensures member satisfaction by providing superior customer service and willingness to help at all time while maintaining a professional demeanor.
• Educates members, family, providers and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email or telephonically.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution.
• Escalates appropriate member issues to management or other departments as required.
• Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance.
• Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids.
• Takes ownership of the issue, focusing on providing solutions and options for member, as necessary through resolution of member issue.
• Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed.
• Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention.
• Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Scan Health Plan operations, as documented I company policies and procedures.
• Follows all HIPAA requirements.
• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
• Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development.
• Contributes to team effort by accomplishing related results as needed.
• Actively support the achievement of SCAN’s Vision and Goals.

Skills

Call center experience

Customer service

Medicare benefits knowledge

Communication skills

Data entry

Telephone etiquette

Job description

SCAN Health Plan is hiring for a remote Member Service Rep to serve members with benefits, eligibility, referrals, and claims questions. You’ll educate members and caregivers about plan options, explain benefits clearly, and follow up to resolve issues in a timely, compliant manner.

Ideal candidates have 1–2 years in call center or healthcare-related customer service, strong communication, data-entry skills, and the ability to handle high call volumes professionally.