Health Member Services Specialist

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Job description

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

1. Answer inquiries regarding eligibility and confirmation of benefits for coverage of proposed services.
2. Answer inquiries regarding the status of claims payment for all Everence health products.
3. Research and assist in resolving all issues coming into the call center.
4. Work with the cancelation of a policy and strive to retain membership.
5. Provide coverage options for Medicare Supplement products including pricing.
6. 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.
7. Provide appropriate written correspondence to members and providers.
8. Document all customer service contacts.
9. Perform other duties and assignments as requested by the Health Member Services Manager.

QUALIFICATIONS

Experience:

High school graduate

Skills and Abilities:

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

SUPERVISORY RESPONSIBILITIES: None

SCHEDULE: Full-time

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