Member Services Representative – Call Center

Position Summary

The Member Services Representative is primarily responsible for delivering effective customer service for all Common Ground Healthcare Cooperative (CGHC) members and stakeholders by utilizing excellent, in-depth knowledge of company products and procedures. This position will assist members and stakeholders in the areas of enrollment, premium payment, invoicing, benefits and claims. The Representative maintains customer satisfaction by using problem-solving skills and resolving issues for stakeholders.

Essential Duties, Responsibilities

• Follows operating procedures and practices to ensure the highest level of patient/member safety and care.
• Provides a high-level of quality service, consults and assists members and stakeholders in the areas of enrollment, premium payment, invoicing, benefits and claims; services via telephone, email and other
• communication channels.
• Problem solves independently to assist members and stakeholders with questions and/or concerns; escalates
• calls and requests supervisory assistance as appropriate.
• Documents all calls in accordance with operating procedures.
• Performs in accordance of the Member Service's call volume goals and quality measurements.
• Maintains company information and patient information in accordance with HIPAA requirements.
• Performs other duties as assigned.

Knowledge and Skill Requirements

• High School graduation or equivalent required.
  Preferred: Bachelor's degree from an accredited college or university.
• One to two years customer service experience with "customer interaction".
  Preferred: Call Center experience and/or health insurance experience and/or medical claims processing experience; knowledge of HIPAA requirements.
• Outstanding verbal and written communication skills.
• Proficient with keyboarding and computer navigations skills; typing skills must be at minimum of 25 words
• per minute accurately.
• Ability to use a professional manner to deal courteously and effectively with members and other
• stakeholders.
• Ability to identify and resolve customer issues by utilizing excellent CGHC product and process knowledge.
• Knowledge of and proven proficiency using personal computers including the use of Microsoft Office
• applications required. Ability to learn and use an insurance system required.
• Must use good judgment and have the ability to act decisively at the right time and exhibit critical thinking.
• Ability to ensure a high level of customer satisfaction.
• Effective interpersonal skills. Ability to be culturally sensitive and work with diverse populations.
• Professional manner to deal courteously and effectively with members and other stakeholders.
• Ability to maintain confidentiality regarding company information acquired on the job required.
• Ability to learn HIPAA requirements for a call-center environment.
• Ability to work extended hours at peak seasonal times or as needed (i.e. past 5:00pm)

General Organizational Requirements

• Maintains attendance and punctuality according to Company standards
• Adheres to Company policies and procedures
• Ability to treat others with dignity, respect, and courtesy
• Ability to maintain patient, employee, and proprietary confidentiality
• Ability to communicate effectively in-person and in all forms of communication
• Ability to provide professional image and act professionally
• Ability to be flexible and adapt to changing situations
• Ability to consistently meet or exceed member expectations in performing own work, and to follow operating
• procedures and practices to ensure the highest level of patient/ member safety and care
• Ability to use effective customer service techniques and effective interpersonal skills required
• Ability to learn new information and integrate processes

Physical Demands and Work Environment

Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions. This position operates in a call-center office setting in a very fast-paced environment. This role routinely uses Call Center system applications, standard office equipment, including computers, phones, headsets, photocopiers, and fax machines. While performing the duties of this job, the individual is regularly required to talk, hear and sit for prolonged periods of time.