Health Member Services Specialist

POSITION SUMMARY

Answer inquiries, resolve issues, and handle customer (internal and external) concerns while maintaining a professional image through superb telephone etiquette and excellent customer service. Serve as a key member of a cross-functional team responsible for incoming and outgoing customer services for members, consultants, and others as related to Everence health products.

RESPONSIBILITIES AND DUTIES

• Answer inquiries regarding eligibility and confirmation of benefits for coverage of proposed services.
• Answer inquiries regarding the status of claims payment for all Everence health products.
• Research and assist in resolving all issues coming into the call center.
• Work with the cancelation of a policy and strive to retain membership.
• Provide coverage options for Medicare Supplement products including pricing.
• Maintain an understanding of Everence third-party administration products and services; Medicare and Medicare Supplement plans; Medicaid; corporate policies, and product-specific policies; procedures and business rules for the above-named products.
• Provide appropriate written correspondence to members and providers.
• Document all customer service contacts.
• Perform other duties and assignments as requested by the Health Member Services Manager.

QUALIFICATIONS

Experience:

High school graduate

Skills and Abilities:

• Ability to obtain and maintain a license in Health insurance
• Excellent verbal and written interpersonal and communication skills including a high level of listening skills
• Customer-oriented with the ability to adapt and respond to different types of customers with sensitivity
• Demonstrates initiative
• Ability to make quick and appropriate decisions despite interruptions
• Flexibility with changing work patterns and/or varying workloads
• Excel at problem-solving
• Attention to detail with the ability to multi-task and prioritize while managing time effectively
• Proficient computer skills and solid knowledge of Microsoft Office programs
• Ability to develop and maintain a strong sense of teamwork
• Medical and insurance background desirable
• Fluency in Spanish preferred
• Must be able to maintain call center hours (currently weekly 8 am to 5 pm)

SUPERVISORY RESPONSIBILITIES: None

SCHEDULE: Full-time