Medicare Advantage Member Services Representative

SIHO Insurance Services • Columbus, OH

20h • Hybrid

About The Position

SIHO Insurance Services is seeking a Medicare Advantage Member Services Representative to help create an excellent experience for SIHO members and providers. The role primarily responds to telephone inquiries, and may also handle written inquiries and assist walk-in members. It supports Medicare Advantage/MyTruAdvantage products and is a non-exempt position. The position is based in Columbus, Indiana; candidates must live in or be willing to commute to Columbus, and remote work or relocation is not available as the work location arrangement. The schedule is full-time and hybrid, with three days in the office and two days remote.

The annual schedule is divided into peak season, October 1 through March 31, and off-peak season, April 1 through September 30. During peak season, team coverage is required seven days a week from 8 a.m. to 9 p.m. Available shifts are 8 a.m.–5 p.m., 9 a.m.–6 p.m., 12 p.m.–9 p.m. (remote), and 10 a.m.–7 p.m. as needed. Employees must work at least two weekends per month, on remote shifts of 12 p.m.–9 p.m. or 10 a.m.–7 p.m. During off-peak season, coverage is Monday through Friday between 8 a.m. and 9 p.m., with available shifts of 8 a.m.–5 p.m., 9 a.m.–6 p.m., or 12 p.m.–9 p.m. Employees must work one late shift per week. Schedules are provided one month in advance, with consideration for employee preferences.

Requirements

• High school diploma.
• Two years of customer service experience.
• Working experience with Microsoft Office or comparable software.
• Excellent oral and written communication and strong listening skills.
• General knowledge and understanding of health insurance.
• Ability to proactively provide solutions using strong emotional intelligence, while ensuring members’ health and safety.
• Ability to maintain attendance to support required work quality and quantity.
• Professional appearance and presence.
• Commitment to confidentiality in accordance with HIPAA guidelines.
• Availability to work at least two weekends per month during peak season.
• Reside in or be willing to commute to Columbus, Indiana.

Nice To Haves

• Knowledge of Medicare Advantage.

Responsibilities

• Help members navigate their healthcare needs by explaining benefits, resolving claim concerns, finding nearby doctors, and acting as a healthcare advocate.
• Respond to member and provider inquiries, primarily by telephone, and also handle written inquiries and assist walk-in members as needed.
• Address customer needs while complying with regulatory requirements, including handling complex benefit questions.
• Record details of inquiries, comments, complaints, and transactions.
• Escalate unresolved and pending customer grievances.
• Strive for first-call resolution and proactively resolve members’ questions and concerns.
• Work with other departments and doctors’ offices to resolve customer concerns.
• Support teammates and perform other relevant duties as business needs require to help achieve department and company-wide goals.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED