Member Service Representative

Position Overview

This Membership Services Representative role will report to the Manager of Member and Provider Services and plays a unique and important role in our mission to change healthcare for the better. Experience in the healthcare industry, critical thinking, and compassionate communication skills will help build an effective and efficient Membership Services Team. The representative will take inbound calls from Peak Health members, answer questions ranging from general information to complex inquiries, work with management and peers to research and resolve member issues, and make outbound calls to members for issue resolution or to gather additional information.

Ability to think critically and communicate effectively while following organizational policies and procedures is essential.

• High School diploma or GED.
• Two (2) years of customer service experience in a call‑center environment.

• Associate degree or greater in a related healthcare field.
• Two or more years of experience in a fast‑paced call environment with processing and/or customer service experience.

• Verify member information while addressing general questions.
• Respond to and resolve all issues/inquiries to assure an efficient and seamless member experience.
• Maintain open channels of member communications, doing outreach as required.
• Meet all production and quality standards, maintaining work queues according to department standards.
• Effectively communicate with internal and external staff.
• Elevate issues to the next level of supervision as appropriate.
• Ensure accuracy of information gathered and shared on a member’s behalf.
• Attend all required training classes, demonstrating proficiency and ability to learn.
• Perform other duties as deemed appropriate by the Management Team.
• Maintain accurate documents, including time‑keeping records.

• Ability to sit for extended periods of time.
• Ability to answer phone calls for extended periods of time.
• Lifting 10-25 lbs.
• Travel requirement: 0%-25%.

• Standard office environment with electrical equipment (telephone, personal computer, copier, fax machines, etc.).
• Computer software/systems include but are not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC.

• Working knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to take direction and navigate through multiple systems simultaneously.
• Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.
• Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
• Familiarity with medical insurance services process.
• Requires exceptional attention to detail, the ability to be organized, and the ability to perform multiple tasks simultaneously.
• Ability to work remotely – includes reliability, self‑motivation, focus & time‑management skills.
• Ability to communicate clearly, concisely, and articulately while being an astute listener.

• Scheduled Weekly
  
  Hours:
  
  40
• Shift: Exempt/Non‑Exempt:
  United States of America (Non‑Exempt)
• Company: PHH Peak Health Holdings
• Cost Center: 2911 PHH Member Services