Membership Service Representative (MSR) is the first level contact for members, providers, and potential members who contact our Member Services Department. The MSR is responsible for answering incoming telephone inquiries regarding benefits, PCP changes, pharmacy, eligibility, claims and other aspects of plan benefits; and placement of outbound calls to members, providers, health plan providers and identifies opportunities to improve our member and provider experiences. 

KNOWLEDGE/SKILLS/ABILITIES
 

• Supports inbound/outbound phone calls from members or providers.
• Accurately documents all member or provider calls.
• Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
• Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations.
• Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the member or provider’s needs.
• Achieves individual performance goals established for this position in the areas of, call quality, attendance, schedule adherence and individual performance goals as it relates to call center objectives.
• Engages and collaborates with other departments.
• Demonstrates personal responsibility and accountability by taking ownership of the call and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the member and/or provider to escalate issues based on established risk criteria.
• Responds to and resolve the customers inquiries by identifying the topic and type of assistance the caller needs such as  assistance involving their eligibility, ID cards, Member, PCP changes, and personal information updates etc.
• Supports provider needs for basic inquiries and assistance involving member eligibility and covered benefits.
• Proactively engages and collaborates with other departments as required.
• Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations.
• Communicates professionally

Qualifications:

• Must have at least High School diploma
• Bilingual and fluent in Spanish - required, language will be tested for fluency
• Computer skills to include word processing and excel
• Must have strong verbal, written, and interpersonal communication skills
• Must have excellent customer service skills and demonstrate respect, patience, and helpfulness with customers and co-workers
• Must be responsible, detail-oriented, and professional
• Must understand and comply with HIPAA (patient privacy) regulations
• Prior experience in a customer service environment and/or familiarity with the medical/healthcare industry is preferred but not required