[Hiring] Member Service Representative @WVU Medicine

Role Description

This position will report to the Manager of Member and Provider Services, playing a unique and important role in our mission to change healthcare for the better.

• Experience in the healthcare industry, critical thinking, and compassionate communication skills will help the organization build an effective and efficient Membership Services Team.
• The Membership Services Representative will take inbound calls from Peak Health members, answering questions ranging from general information to complex inquiries on a wide range of issues.
• The Membership Services Representative will work with management and peers on the Peak team to research and resolve member issues and questions.
• This role, in addition to taking inbound calls, will make outbound calls to members with issue resolution or to gather further information.
• Ability to think critically and communicate effectively while following organizational policies and procedures is a must.

Qualifications

• High School diploma/GED
• Two (2) years of customer service experience in a call center environment
• Associate Degree, or greater, in related healthcare field (preferred)
• Two plus years’ experience in a fast-paced call environment with processing and/or customer service experience (preferred)

Requirements

• Verify member information while addressing general questions.
• Respond to and resolve all issues/inquiries to assure an efficient and seamless member experience.
• Maintain open channels of member communications doing outreach as required.
• Meet all production and quality standards, maintaining work queues according to department standards.
• Effectively communicate with internal and external staff.
• Elevate issues to next level of supervision, as appropriate.
• Ensure accuracy of information gathered and shared on a member’s behalf.
• Attend all required training classes, demonstrating proficiency and ability to learn.
• Other duties as deemed appropriate by the Management Team.
• Maintain accurate documents, including timekeeping records.

Physical Requirements

• Ability to sit for extended periods of time.
• Ability to answer phone calls for extended periods of time.
• Lifting 10-25 lbs.
• Travel Requirement: 0%-25%

Working Environment

• Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.).
• Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC.

Skills and Abilities

• Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.
• Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
• Familiarity with Medical insurance services process.
• Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
• Ability to work remotely – this includes reliability, self-motivation, focus & time management skills.
• Ability to communicate clearly, concisely, and articulately while being an astute listener.

Additional Job Description

• Scheduled Weekly Hours: 40
• Shift: Exempt/Non-Exempt
• United States of America (Non-Exempt)
• Company: PHH Peak Health Holdings
• Cost Center: 2911 PHH Member Services