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Medicare Advantage Member Services Representative

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Posted: 06/11/2024

SIHO’s Member Services Representatives assist in creating an excellent experience for SIHO’s members and their providers. The primary responsibility of this position is to respond to member’s and providers inquiries. This position mainly responds to telephonic inquiries but may also be responsible for responding to written inquiries and assisting walk-in members. This is a non-exempt position that does require ability to work some weekends throughout the year.

Brief Description of Duties:

  • Assist members with navigating their healthcare needs by explaining benefits, solving claim concerns, finding a doctor nearby or being their healthcare advocate
  • Comply with regulatory requirements while addressing customer needs which may include complex benefit questions.
  • Record details of inquiries, comments, complaints, and transactions.
  • Escalate unresolved and pending customer grievances.
  • Support teammates as business needs require to ensure the organization is meeting the needs of our members and providers
  • Strive for first call resolution while demonstrating SIHO’s dedication to proactively work to resolve members questions and concerns.
  • Work with partners in other departments, or to Doctors’ offices to help resolve a customer concern.
  • Support your teammates as business needs require to ensure we are meeting the needs of our customers.
  • Performs other relevant duties deemed necessary to achieve department and company-wide goals.

Traits we are looking for:

  • Trustworthy Empathic Proactive
  • Compassionate Good Listener Problem Solver
  • Communicator Patient Personable & Collaborative

Minimum Skills Requirement:

  • Possess a passion for customer service
  • Excellent communications (oral and written) and strong listening skills
  • General knowledge and understanding of health insurance
  • Knowledge of Medicare Advantage is preferred, but not required
  • This job calls for strong emotional intelligence to proactively provide solutions, ensuring the member's health and safety
  • Ability to maintain attendance to support required quality and quantity of work
  • Professional appearance and presence
  • Commitment to support and maintain confidentiality in conformance to HIPAA guidelines
  • This position requires some evening shifts as late as 9:00 pm with the possibility of weekends.

Required Education:

  • High School Diploma and 2 years of Customer service experience
  • Working experience of Microsoft Office or other comparable software

*All positions are subject to change based on the needs of the business