Member Services Representative

Job Summary:

The Member Service Representative is responsible for providing exceptional customer service to members regarding Employee benefits, billing, enrollment and claims inquiries in a Call Center environment. The representative will provide courteous, empathic, and professional service while providing accurate and timely responses. Under supervision, the representative is responsible for complex Customer Service duties following established procedures in all benefits-related areas including processing life events, new hire and open enrollments, researching benefit, eligibility, billing and claims issues.

Primary Duties and Responsibilities

The duties listed below are some of the duties that may be assigned and may not include all responsibilities that the person in this role may be asked to perform. Incumbent may be required to perform other related duties as assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties:

• Responsible for assisting in all customer service- related functions. Responsible for customer service-related duties following established procedures in all benefits-related areas.

o Handles incoming requests from customers, group administrators and carriers in a call center environment. Responsible for resolving issues/requests accurately and timely. Requests are received via multiple channels: inbound calls, incoming SMS, faxes, chats, and emails and from internal and external sources.

o Provides forms and other benefit related information and documents upon request to Members.

o Answers questions and provides information regarding benefit eligibility, coverage amounts and options, documentation, claims forms, claims filing and processes for employees, group administrators and carriers.

o Expected to demonstrate knowledge of Ancillary benefits, enrollment processes, billing, payroll deductions, carrier claim processes and Flexible Spending Accounts.

o Employs active listening skills to better understand caller’s issues and needs, build trust and rapport to lead to better issue resolution.

o Able to identify Member issues and escalate to manager for resolution.

• Under supervision, performs complex customer service duties including new hire and open enrollments, life event processing for members
• Assist with departmental projects as needed

Scope of Supervisor Responsibility

• None

Education

• Bachelor’ Degree Preferred

Skills and Qualifications:

• Excellent oral and written communication skills.
• Excellent active listening skills to better understand client’s needs.
• Ability to handle urgent, sensitive situations with empathy and professionalism.
• Ability to work well within a team and be a team player.
• Ability to demonstrate effective organizational skills
• Ability to troubleshoot and resolve customer issues.
• Ability to multi-task and manage changing job demands
• Experience with Microsoft Office (Word, Excel, Outlook, OneNote and PowerPoint)
• Experience with Call Center software programs preferred
• Experience with Microsoft Teams preferred
• Experience with Customer Relationship Management systems (CRM) preferred
• Experience with Electronic Enrollment platforms (Selerix) preferred
• Core and Ancillary product knowledge preferred
• Arkansas producer Life and Health license must be obtained upon employment

Work Experience Required for this Role

• 2 years of work experience: customer service, dental or medical billing experience a plus or related experience

Attendance Requirements:

• Hybrid role
• The Company reserves the right to require in-person attendance at the Company’s worksite at any time. The Company also reserves the right to make full-time attendance at the Company’s worksite an essential job function for this position if attendance becomes necessary to increase productivity, to develop teamwork, to conduct training, to better address customer needs, or to accomplish any other valid business goal. If full-time attendance requirements for this position materially change, the Company will provide thirty (30) days’ prior notice of the change.

Position Type/Expected Hours of Work:

• This is a full-time position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5 p.m. Occasional evening and weekend work may be required as job duties demand.

Travel:

No travel anticipated

Physical Abilities Required for this Job:

The physical demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential functions.

• While performing the duties of this job this individual is regularly required to sit for extended periods of time. Required to walk, sit, talk/speak clearly, hear, use their hands and fingers (manual dexterity), and occasionally lift and /or move up to fifteen pounds.
• Specific vision abilities required by this position include close vision, and the ability to adjust focus.

Mental Abilities Required for this Job:

• The ability to guide and assist callers with urgent, sensitive and or/emotionally challenging situations/issues with empathy and professionalism.
• The ability to solve problems, make decisions, interpret data, organize information, excellent written and oral communication skills.
• Active listening skills to better understand clients needs.

NOTE: This job description in no way states or implies that these are the only duties to be performed by the employee(s) of this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the employee(s) will possess the skills aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an at will relationship.

The company is an equal opportunity employer, drug-free workplace, and complies with ADA regulations as applicable.