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Job Description

As a Member Services Representative, you will be a part of a team that transforms customer service into Customer Care by delivering an amazing experience. You will assist beneficiaries with a wide range of critical services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan. Qualified candidates will have a strong desire to help people with strong customer care skills, attention to detail, and highly organized.

ESSENTIAL DUTIES AND RESPONSIBILITIES

As our customers share concerns and provide us with valuable feedback, your ability to recognize and complete the steps necessary to meet their needs will leave a permanent, lasting impression of the passion you have for helping them be at their best.

We make sure our customers are not alone when it comes to understanding their benefits and they will rely on you to advocate for them as you would your own family member.

In addition to the keys to success identified above that you will bring with you to the team, you will need to demonstrate the following abilities:

+ Update account information such as billing options and changes of address or phone numbers.

+ Research premium billing discrepancies and prescription claims processed.

+ Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage.

+ Complete survey for Coordination of Benefits (COB) for member with multiple coverages.

+ Submit Verbal Attestation on behalf of member for Late Enrollment penalties(LEP)

+ Displays positive demeanor, technical accuracy, and conformity to company policies.

+ Understands CMS Guidance and ensures applicable Exhibits are being mailed per CMS Guidance.

+ Ensure HIPAA regulations are maintained within the immediate environment.

+ Responsible for concise and detailed notations as it pertains to member records.

+ Handles outbound calls for purposes of validating information.

+ Handles inbound calls by assisting members with a high level of accuracy and efficiency.

+ Escalates any member issues to management as necessary.

+ Responsible for maintaining a high level of call quality as set by client standards, which includes a 95% quality score, and answering 80-85% of calls within 30sec or less

+ Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.

+ Conform with and abide by all regulations, policies, work procedures and instructions.

+ Respond promptly when returning telephone calls and replying to correspondence and faxes.

+ Act, dress, and behave in a professional manner to reflect a positive image of the company.

MONTHLY GOALS:

+ Meet average QA score of 95%

+ Comply with attendance guidelines

+ Schedule adherence of 90% or higher

+ Maintain AHT below certain standards

EDUCATION AND EXPERIENCE:

+ Associate Degree preferably in Healthcare

+ Minimum 3 years working in a fast paced high volume call center environment, retail customer service, preferably in healthcare or hospitality

+ Ability to multi-task effectively with strong attention to detail when documenting customers reasons for calling

Payrate: $16.32 per hour

About Us

WHO WE ARE

Convey Health Solutions manages a myriad of administrative needs and make it easier for health plans to operate and provide valuable experiences for their members. How so? We focus on building specific technologies and services that uniquely meet the needs of government-sponsored health plans.

OUR MISSION

To improve health plan operations and elevate the customer experience.

OUR VISION

Empowering health plans to excel through technology, service and advisory experience.

OUR VALUES

Integrity First - Inspired Teamwork - Compliance Matters