[Hiring] Member Services Agent @Southern Scripts

Role Description

The member services agent is responsible for providing effective customer service for all internal and external customers by using excellent, in-depth knowledge of company products and programs as well as communicating effectively with team members within the customer service department.

• Knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Confer with customers by telephone to provide information about Rx claims processing.
• Keep detailed records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
• Follow-up to ensure that appropriate changes were made to resolve customers' problems.
• Refer unresolved customer grievances to designated departments for further investigation.
• Review Rx insurance policy terms to determine whether a claim is covered for employer group.
• Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
• Resolve customers' service or billing complaints.
• Obtain and examine all relevant information to assess validity of complaints and to determine possible causes.
• Abide by all obligations under HIPAA related to Protected Health Information (PHI).
• If a HIPAA violation is discovered, report the violation to the Compliance Officer and/or Human Resources.
• Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
• Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.

Qualifications

• High School or equivalent.
• Customer service experience.
• Computer experience.

Requirements

• Interacting with Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
• Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
• Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
• Communicating with Persons Outside Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources.
• Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
• Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
• Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.
• Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work.
• Performing Administrative Activities — Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
• Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
• Customer and Client Focus.
• Problem Solving and Analysis.
• Time Management.
• Communication Proficiency.
• Teamwork Orientation.
• Technical Capacity.
• Multitasking.

Benefits

• Medical, Dental, Vision Insurance.
• Disability and Life Insurance.
• Employee Assistance Program.
• Remote Work Options.
• Generous Paid-Time Off.
• Annual Reviews and Developmental Plans.
• Retirement Plan with Company Match Immediately 100% Vested.

Position Type and Expected Hours of Work

This is a full-time, hourly position. Days and hours of work vary on shift assigned. The Call Center core hours of operation are Monday – Friday 6a – 10p, Saturday 6a – 8p, and Sunday 6a - 8p.

Travel

Minimal travel expected for this position to Natchitoches, Louisiana for training and development.