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Member Service Representatives

SIHO Insurance Services
Job Description

This is a non-exempt position with primary responsibility of responding to members and providers questions for MTA and SIHO lines of business, preparing reports, documenting complaints, and clarifying benefits changes or exclusions. This position may also be responsible for reviewing, analyzing and approving routine health claims for payment.


Brief Description of Duties:

Respond to incoming calls from members and providers
Assist members by solving issues relating to their health care coverage
Assist walk-in customers
Achieve individual performance goals as it relates to call center objectives
Engage and collaborate with other departments as applicable
Review claims that have processed to assist members and providers
Utilize Web based programs to assist members and providers
Determine if services are covered by the health plan by utilizing plan descriptions
Complete special projects (including research) as assigned by Member Services Management
Understand and follow mandated (i.e., HIPAA, ERISA, Etc.) regulations promulgated by state or federal governmental agencies
Develop and maintain statistical data as required
Comply with regulatory requirements
Responds to internal and external customers in a timely manner, treating them with respect and courtesy

Traits we are looking for:

  • Possess a passion for customer service
  • Excellent communications (oral and written) and strong listening skills
  • Experience in healthcare is preferred, but not required
  • General knowledge and understanding of health insurance
  • 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

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

Contact Information

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