Customer Service Representative Level Iii

Customer Service Representative Level III – Member Services (Job Description)

Advantage PHC seeks an experienced health insurance Member Services Representative to join our growing team. Our goal is to provide assistance and seamlessly navigate a member's health plan, answering questions, finding doctors, finding the most affordable care, negotiating pricing, and more.

Overview

This Customer Service role is responsible for assisting and guiding daily activities in the member services function for various health plans. They will collect data on member inquiries and service requests to recommend solutions. Representatives help customers understand their insurance plan and benefits and answer questions, such as finding a provider in network, pharmacy benefits, pre-authorizations, explain benefits within a member guide, and help them find the best provider for their needs.

Responsibilities:

• Develop a solid understanding of our service offerings so you’re able to investigate and resolve member questions, including escalations from Customer Service Representatives
• Understand and communicate health plan details: Familiarizing yourself with plans, up-to-date changes and services, keeping track of all customer inquiries
• Accountable for member/provider satisfaction, retention, and growth by delivering outstanding member service;
• Accept review calls and identify opportunities for improvement;
• Proper call handling and teamwork delivering excellent Customer Service; keep accurate and up-to-date records for performance.
• Achieve daily call volume and quality metrics; maintain performance and quality standards including number of calls, and abandonment rate, constantly strive to reduce call hold times
• Follow training materials, call scripts, and job aides;
• Achieve business results and strive to continuously improve for our customers while ensuring compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements).
• Resolve customer complaints in a diplomatic and calm manner
• Elevate customer complaints to the supervisor as needed

Requirements:

• 5 years of health insurance experience with a solid understanding of claims and benefits;
• High school diploma, general education degree, or equivalent.
• Ability to stay calm when customers are stressed or upset.
• Ability to utilize and navigate multiple computer and software systems simultaneously (Salesforce.com, RingCentral, etc)
• Experience working with customer support.
• Ability to work in a start-up, fast-paced environment

Compensation:

Hourly Range: $26.00- $28.00 depending on skills and experience

100% paid on premiums for medical, dental, and vision coverage

Paid Time Off (PTO), 1% retirement savings plan match

Job Type: Full-time

Pay: $26.00 - $28.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience level:

• 5 years

Shift:

• Day shift

Weekly day range:

• Monday to Friday

Work setting:

• Hybrid work

Experience:

• Customer support: 5 years (Required)

Work Location: Hybrid remote in Frisco, TX 75033