Member Service Representative

📋 Description

• • Take inbound calls from Peak Health members to answer questions ranging from general inquiries to complex healthcare-related issues.
• • Make outbound calls to members for issue resolution, follow-up, or to gather additional information.
• • Verify member information accurately while providing clear and compassionate responses to all inquiries.
• • Research and resolve member issues in collaboration with management and team peers to ensure a seamless member experience.
• • Maintain open communication channels with members through proactive outreach as required by department standards.
• • Meet all production and quality metrics, including adherence to work queue standards and response time expectations.
• • Communicate effectively with internal staff and external partners while following organizational policies and procedures.
• • Elevate unresolved or complex issues to the appropriate level of supervision in a timely manner.
• • Ensure the accuracy and confidentiality of all member data gathered, documented, and shared.
• • Attend all mandatory training sessions and demonstrate proficiency in system usage and procedural knowledge.
• • Maintain accurate timekeeping records and other required documentation.
• • Utilize Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC systems to perform daily tasks.
• • Navigate multiple systems simultaneously while managing high call volumes and administrative duties.
• • Apply predefined methods and guidelines to solve problems efficiently and improve customer satisfaction.
• • Demonstrate exceptional attention to detail, organizational skills, and the ability to handle multiple tasks concurrently.
• • Work reliably in a remote environment with strong self-motivation, focus, and time management skills.
• • Communicate clearly, concisely, and articulately while actively listening to member concerns.
• • Maintain familiarity with medical insurance services processes and procedures.
• • Perform duties in a standard office environment using standard office equipment including telephone, computer, and fax machines.
• • Sit for extended periods and answer phone calls for prolonged durations as part of daily responsibilities.
• • Lift and move items weighing 10–25 lbs. as needed.
• • Work a scheduled 40-hour week in a non-exempt role.