The Member Services Representative (MSR) provides benefits coordination and customer service for members in all Alliance lines of business. The MSR is the first point of contact for members, their families/guardians/caretakers and is a liaison between the plan, the provider network, and other community agencies. The MSR provides courteous, professional and accurate responses to incoming inquiries regarding network, plan benefits, eligibility, authorizations, plan guidelines and policies and processes, as well as claims and pharmacy issues.
Principal responsibilities include:
· Answer incoming calls, emails, and other requests for assistance in a timely manner in accordance to departmental performance targets and provide excellent customer service while doing so.
· Provide accurate benefit information (including copays, benefit limits, and exclusions) to potential and current Alliance members.
· Assist members in resolving problems with their health coverage and implement first-call resolution protocols.
· Properly document all calls/contacts as required by department standards.
· Participate in regularly scheduled department meetings and trainings.
· Escalate complex issues per departmental standards.
· Connect members to the provider of their choice and support/educate members in the maintenance of the provider relationship.
· Make outgoing calls to members as directed by other departmental needs and initiatives.
· Adopt and understand changes in benefits, work processes, and systems.
· Create and/or collaborate on communications pieces and member material items.
· Work in a cooperative manner with other departments.
· Support continuous improvement of call center effectiveness through the development, evaluation, and refinement of policies and procedures that meet the operational and regulatory goals and requirements.
· Maintain strict confidentiality of all sensitive information and issues.
· Participate in member orientations and other outreach events when requested by Member Services management.
· Complete other duties and special projects as needed.
EDUCATION OR TRAINING EQUIVALENT TO:
· Two years of college or equivalent work experience.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· Minimum two years direct customer service experience.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Fluent in a threshold language desired: Spanish, Cantonese or Vietnamese.
· Fluent in Mandarin, Tagalog, Farsi, Korean, and/or Punjabi highly desirable.
· Fluent in English required.
· Strong customer service background.
· Ability to type at least 50 WPM.
· Ability to communicate effectively, both verbally and in writing.
· Possess strong interpersonal, communication, and listening skills.
· Possess problem analysis and problem-solving skills.
· Possess attention to detail and accuracy with solid adaptability skills.
· Ability to work effectively in a multidisciplinary company.
· Proficient experience in use in Windows including Microsoft Office suite.