What are the responsibilities and job description for the Member Resolution Specialist position at OneShare Health?
OneShare Health, LLC., based in Irving Texas is a medical cost sharing ministry providing a unique and affordable, ACA-exempt path to healthcare. Our core value is the biblical imperative of giving to and serving others. With industry-leading membership programs and an unparalleled member experience, OneShare Health is passionate about finding ways to fulfill our ministry to members, staff, and other charitable organizations.
As a condition of employment, each employee will be required to affirm that he or she will be able to carry out all employment duties in a way that supports and is consistent with OneShare Health's Christian mission, vision, scriptural foundation, values, and beliefs found on our website at About Our Christian Health Care Sharing Ministry | OneShare Health
Job purpose
The Member Resolution Specialist is responsible for providing excellence in customer service to OneShare members. This specialized role receives information from the member support team for inquires which require various levels of additional research, conducts all necessary fact-finding activities, coordinates the efforts of various other departments, and drives the member inquiry to closure and/or resolution. The position is heavily focused on outbound calling in support of resolving the members’ needs and providing updates and results of research activities.
Areas of Accountability / Main Activities/ Expected Results:
Area No. 1: Member Resolution Responsibilities
Main Activities:
Responds to inquiries from members originating from the member support team which require various levels of research.
Conducts research on member inquiries to determine information needed and course(s) of action for resolution.
Makes outbound calls with the goal of resolving the member need and/or providing updates.
Effectively, compassionately, and professionally communicates information relating to member support inquiries.
Regularly receives requests from member support team relating to member inquiries requiring additional research for resolution.
Conducts thorough and complete research relating to inquiries, engaging cross-functional departments as appropriate.
Serves as a liaison to the training department.
Provides feedback to member support on items incorrectly entered as cases which could have been resolved in accordance with one-call resolution.
Accurately documents all provider and member interactions in a timely manner and in accordance with internal policies and procedures.
Ensures cases are opened and closed in accordance with internal policies and guidelines.
Area No. 2: Cross-Functional Collaboration
Main Activities:
Research cases opened by member support team when inquiries require additional research and cannot be resolved in accordance with “one-call resolution” standards and guidelines.
Accurately documents all provider and member interactions in a timely manner and in accordance with internal policies and procedures.
Consistently adheres to standards, processes, protocols including but not limited to attendance, schedule adherence, service level agreements (SLA’s)and various contact center-specific policies and procedures.
Meets quality, quantity, and timeliness standards to achieve individual and department performance goals.
Continually meets and exceeds quality assurance call audit standards.
Education / Certification(s) / Experience / Skills(s)
High School Diploma or equivalent required. Degree/Certificate a plus.
2 years’ experience in a similar, health care role.
Demonstrated excellence in professionalism and customer service abilities.
Demonstrated excellence in written, verbal, and interpersonal communications.
Demonstrated ability to problem solve, think critically, and apply abstract knowledge and concepts to resolve multi-faceted issues.
Comprehension of medical terminology and coding or ability to learn.
Familiarity with Microsoft Office strongly preferred.
Familiarity with Salesforce helpful but not required.
Strong attention to detail and accuracy in a fast-paced environment.
Work Environment
Typically exposed to routine office noises such as printers, phones, and work interruptions via email, instant messaging, telephone and in-person.
Physical Demands
Prolonged periods sitting at a desk and working on a computer.
EEO Statement:
OneShare Health endeavors to retain, encourage, and promote the most qualified individuals and avoid discrimination on the basis of race, traits historically associated with race, color, sex, age, national origin, disability, genetic information, pregnancy, childbirth, or related medical conditions, or any other basis protected by applicable federal, state laws, or local law (all as defined by applicable law) from which OneShare Health and/or certain positions at OneShare Health are not exempt under applicable law and OneShare Health rights as a religious ministry. We welcome a diverse staff composed of those who commit to carrying out their employment duties consistent with OneShare Health’s nature as a Christian ministry.
As a condition of employment, each employee will be required to affirm that he or she will be able to carry out all employment duties in a way that supports and is consistent with OneShare Health's Christian mission, vision, scriptural foundation, values, and beliefs found on our website at About Our Christian Health Care Sharing Ministry | OneShare Health
Job purpose
The Member Resolution Specialist is responsible for providing excellence in customer service to OneShare members. This specialized role receives information from the member support team for inquires which require various levels of additional research, conducts all necessary fact-finding activities, coordinates the efforts of various other departments, and drives the member inquiry to closure and/or resolution. The position is heavily focused on outbound calling in support of resolving the members’ needs and providing updates and results of research activities.
Areas of Accountability / Main Activities/ Expected Results:
Area No. 1: Member Resolution Responsibilities
Main Activities:
Responds to inquiries from members originating from the member support team which require various levels of research.
Conducts research on member inquiries to determine information needed and course(s) of action for resolution.
Makes outbound calls with the goal of resolving the member need and/or providing updates.
Effectively, compassionately, and professionally communicates information relating to member support inquiries.
Regularly receives requests from member support team relating to member inquiries requiring additional research for resolution.
Conducts thorough and complete research relating to inquiries, engaging cross-functional departments as appropriate.
Serves as a liaison to the training department.
Provides feedback to member support on items incorrectly entered as cases which could have been resolved in accordance with one-call resolution.
Accurately documents all provider and member interactions in a timely manner and in accordance with internal policies and procedures.
Ensures cases are opened and closed in accordance with internal policies and guidelines.
Area No. 2: Cross-Functional Collaboration
Main Activities:
Research cases opened by member support team when inquiries require additional research and cannot be resolved in accordance with “one-call resolution” standards and guidelines.
Accurately documents all provider and member interactions in a timely manner and in accordance with internal policies and procedures.
Consistently adheres to standards, processes, protocols including but not limited to attendance, schedule adherence, service level agreements (SLA’s)and various contact center-specific policies and procedures.
Meets quality, quantity, and timeliness standards to achieve individual and department performance goals.
Continually meets and exceeds quality assurance call audit standards.
Education / Certification(s) / Experience / Skills(s)
High School Diploma or equivalent required. Degree/Certificate a plus.
2 years’ experience in a similar, health care role.
Demonstrated excellence in professionalism and customer service abilities.
Demonstrated excellence in written, verbal, and interpersonal communications.
Demonstrated ability to problem solve, think critically, and apply abstract knowledge and concepts to resolve multi-faceted issues.
Comprehension of medical terminology and coding or ability to learn.
Familiarity with Microsoft Office strongly preferred.
Familiarity with Salesforce helpful but not required.
Strong attention to detail and accuracy in a fast-paced environment.
Work Environment
Typically exposed to routine office noises such as printers, phones, and work interruptions via email, instant messaging, telephone and in-person.
Physical Demands
Prolonged periods sitting at a desk and working on a computer.
EEO Statement:
OneShare Health endeavors to retain, encourage, and promote the most qualified individuals and avoid discrimination on the basis of race, traits historically associated with race, color, sex, age, national origin, disability, genetic information, pregnancy, childbirth, or related medical conditions, or any other basis protected by applicable federal, state laws, or local law (all as defined by applicable law) from which OneShare Health and/or certain positions at OneShare Health are not exempt under applicable law and OneShare Health rights as a religious ministry. We welcome a diverse staff composed of those who commit to carrying out their employment duties consistent with OneShare Health’s nature as a Christian ministry.