at Point32Health in Chicago, Illinois, United States
Job Description
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.
Job Summary
Under the general direction of the Service Center Supervisor, the Member Services Representative is responsible for providing accurate and thorough interpretation of Point32Health benefits, claims processes, eligibility, and enrollment policies to members, employers, and internal customers. In addition, the Member Services Representative is responsible for resolution of complex customer inquiries, the facilitation of problem resolution, and meeting or exceeding customers’ expectations. The Member Services Representative presents a consistent and professional demeanor to all callers and internal customers and is expected to identify opportunities to improve customer service and efficiency. The Member Services Representative is expected to take responsibility for every interaction with a customer by providing outstanding service as a means to build customer loyalty, improve customer retention, and satisfy corporate customer service goals and objectives.
Key Responsibilities/Duties – what you will be doing
- Receives and responds to a high volume of incoming telephone calls from members, prospective members, employers, and internal Point32Health staff.
- Efficiently and effectively processes member calls. This includes:
- Accesses the most appropriate source of information and proficiently resolving the member’s concern.
- Accurately documents the complete encounter and maintains a professional and supportive attitude throughout the call.
- Asks probing questions and takes the opportunity to educate members to avoid unnecessary repeat calls.
- Investigates member complaints and performs front-line analysis and intervention when appropriate.
- Makes necessary outgoing phone calls to resolve member related inquiries.
- Meet or exceed department established key performance indicators.
- Adheres to assigned schedules to ensure appropriate phone queue coverage.
- Demonstrates strong written (e.g., documents calls accurately and comprehensively) and verbal skills.
- Employs active listening skills, demonstrates patience and empathy, and is able to handle difficult customers tactfully, courteously and professionally.
- Strives for improved efficiency for processing member issues.
- Interacts and forms contacts with other Point32Health departments in order to resolve issues.
- Participates in initiatives and/or responds to requests for help to contribute to team and department success.
- Assists in mentoring new staff as directed.
- Assist with department projects as needed.
Qualifications – what you need to perform the job
EDUCATION:
- High School Diploma or equivalent required. Associates degree or equivalent work experience preferred.
EXPERIENCE:
- 6-12 months of relevant experience.
- Preferred customer service experience in health care, call center or corporate office.
- Knowledge of medical terminology is preferred.
- Prior experience training and working in a virtual/remote setting is strongly preferred.
SKILL REQUIREMENTS:
Technical Skills:
- Must have strong computer and telephone multitasking skills
- Must have the ability to navigates through multiple systems
- Accuracy in data input and documentation
- Proficiency with MS Windows
- Proficient keyboard skills
Interpersonal Skills:
- Excellent verbal and written communication skills are required
- Strong organizational skills
- Ability to research and respond to a high volume of telephone inquiries in a consistent and professional manner
- Basic math, grammar, and spelling are required
- Ability to work under pressure and with attention to changing priorities
- Must be able to work cooperatively as part of a team
- Bilingual preferred
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:
- Fast paced office environment handling multiple demands exercising appropriate judgment as necessary.
- Requires a high level of initiative and independence and communication skills sufficient to communicate verbally via telephone.
- Must adapt positively to changes related to work processes, department structure, environment, and technology.
- Involves simultaneous use of a telephone headset, and PC/keyboard for long periods of time in order to document and communicate efficiently.
- Requires long periods of sitting and occasional overtime may be requested.
- May require ability and willingness to work from home.
