Member Services Agent - Temporary

Southern Scripts•Dallas, TX

1d•Onsite

About The Position

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. This role involves understanding principles and processes for providing customer and personal services, including needs assessment, meeting quality standards, and evaluating customer satisfaction. The agent will confer with customers by telephone to provide information about Rx claims processing, keep detailed records of interactions, follow up on customer issues, and refer unresolved grievances to appropriate departments. A key responsibility is reviewing Rx insurance policy terms to determine claim coverage for employer groups and contacting customers with claim investigation results or adjustments. The role also requires resolving customer service or billing complaints, obtaining and examining information to assess complaint validity, and understanding potential causes. Adherence to HIPAA regulations regarding Protected Health Information (PHI) is mandatory, including reporting any discovered violations and completing required HIPAA training. The position requires flexibility, as the job description is not exhaustive and duties may change or new ones may be assigned.

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. This information can be exchanged in person, in writing, or by telephone or e-mail.
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
High School or equivalent.
Customer service experience.
Computer experience.

Responsibilities

Provide effective customer service for all internal and external customers by using excellent, in-depth knowledge of company products and programs.
Communicate effectively with team members within the customer service department.
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).
Report any discovered HIPAA violation to the Compliance Officer and/or Human Resources.
Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.