Member Services Representative - Health Plan Admin at CHRISTUS Ministry System Office

Summary:

The Member Services Representative will play a crucial role in ensuring our members' highest level of customer satisfaction. The Member Services Representative will be responsible for providing exceptional customer service and resolving inquiries, concerns, and complaints professionally and on time. Your primary focus will be on assisting members and providers with their healthcare-related needs, including but not limited to insurance inquiries, benefit explanations, and general account information. Within the Member Services Representative team, this role provides an opportunity for growth and development to the next level as a Member Service Representative Senior within our organization.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Respond to inbound calls, emails, and chat messages from members regarding healthcare-related questions and concerns.
• Provide accurate and timely information about insurance benefits, claims, coverage, and other related inquiries.
• Assist members in navigating through the healthcare system and understanding their rights and responsibilities.
• Support USFHP, HIX, Medicare Advantage, and NCHD LOB as needed.
• Investigate and resolve member complaints, issues, and escalations in a prompt and satisfactory manner.
• Document all customer interactions and issue resolutions accurately and comprehensively in the CRM system.
• Collaborate with internal departments to facilitate issue resolution and ensure a seamless customer experience.
• Explain insurance plans, policies, and procedures to members, ensuring they clearly understand their benefits and coverage.
• Provide guidance on accessing healthcare services, locating in-network providers, and understanding pre-authorization requirements.
• Adhere to established service level agreements (SLAs) and quality standards (> 92%) to ensure consistent delivery of excellent customer service.
• Continuously enhance product knowledge and stay updated on industry trends and changes.
• Participate in training sessions and team meetings to further develop skills and knowledge.
• Identify process improvement opportunities and provide recommendations to enhance the overall member experience.
• Proactively contribute to the development and implementation of customer service best practices.
• Collaborate with team members and management to drive improvements in operational efficiency and customer satisfaction.
• Collaborate with team members and management to implement best practices and streamline workflows. Participate in training sessions and professional development activities to enhance knowledge and skills.

Requirements:

• A High School Diploma or equivalent is required.
• 6 – 12 months experience in the Member Services Department at CHRISTUS Health is required.

Work Type:

Full Time

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