Call Center Member Service Specialist (11:30am-8pm) - Health Alliance Plan

Henry Ford Health•Troy, MI

4d•Hybrid

About The Position

The Call Center Member Service Specialist responds to member, provider, and other customer inquiries by telephone, mail, and in person. The specialist researches and resolves inquiries, complaints, and appeals; explains Health Alliance Plan products, policies, procedures, benefits, and coverage; documents interactions; and directs issues to supporting departments when appropriate. The role monitors workflow and outstanding cases to ensure timely responses and follow-up, maintains confidentiality in accordance with Privacy and HIPAA regulations, and works with internal departments and provider offices to resolve customer needs. The specialist also maintains knowledge of changing policies and procedures, participates in training and continuing education, recommends process improvements based on observed trends, and assists with departmental projects, enrollment periods, outreach activities, and corporate initiatives. This is a hybrid position with a scheduled shift of 11:30 a.m. to 8:00 p.m. Attendance at the Health Alliance Plan building in Troy, Michigan, is required as needed for training, coaching, and computer functionality.

Requirements

Associate degree, or a minimum of four years of recent, related customer service work experience in lieu of the degree.
Completion of a Medical Terminology course within six months after employment, or two years of prior experience in health care or health insurance in lieu of the course requirement.
At least two years of recent customer service or call center experience.
Dependability.
Integrity, patience, maturity, empathy, tact, and diplomacy.
Problem-solving skills, flexibility, good judgment, and the ability to provide service excellence.
Ability to manage assigned projects through successful completion, including appropriate follow-up and documentation.
Ability to handle multiple priorities concurrently in a timely and accurate manner.
Strong interpersonal, listening, verbal communication, and business writing skills.
Efficiency using a PC and various Microsoft programs.
Fundamental understanding of HMO, PPO, and POS delivery systems and claims billing.
Ability to work flexible shifts and overtime, including evenings and weekends, as requested or scheduled.

Responsibilities

Respond to inquiries by inbound and outbound telephone, mail, and in person.
Research and answer inquiries, complaints, and appeals in accordance with department standards, policies, and procedures; direct inquiries to supporting departments when appropriate.
Educate internal and external customers and potential members about Health Alliance Plan products, policies, procedures, benefits, and coverage provisions.
Accurately document incoming inquiries to track member inquiry history and trends.
Maintain confidentiality in accordance with Privacy and HIPAA regulations.
Monitor workflow inboxes and outstanding cases to ensure timely responses, resolution, and follow-up.
Contact internal and external customers by phone or in writing as needed to ensure timely resolution and follow-up.
Work professionally with support departments and maintain strong interdepartmental business relationships.
Keep current on policy and procedure changes in other departments that may affect operations or customer service.
Attend training, development, and continuing education sessions and maintain enhanced skills and performance.
Interact with providers and their staff to obtain information needed to resolve customer inquiries and complaints.
Ensure compliance with department and corporate standards, policies, and procedures.
Recommend process improvements based on observations and customer interaction trends.
Coordinate and assist with departmental projects, member enrollment periods, outreach activities, and corporate initiatives.