Member Services Agent - REMOTE

Southern Scripts•Natchitoches, LA

5d•Remote

About The Position

The Member Services Agent provides effective customer service to internal and external customers using in-depth knowledge of company products and programs and communicating effectively with customer service team members. The role handles inquiries about prescription claims processing, reviews insurance policy terms for employer-group coverage, resolves service and billing complaints, documents interactions, and follows up on customer issues. The agent must comply with HIPAA requirements for Protected Health Information, report discovered violations to the Compliance Officer and/or Human Resources, and complete required HIPAA training. Duties and responsibilities may change or be assigned as needed. This is a temporary, hourly position with varying days and hours based on the assigned shift. The call center operates Monday through Friday from 6 a.m. to 10 p.m., and Saturday and Sunday from 8 a.m. to 10 p.m. On-call responsibilities rotate. No travel is expected.

Requirements

High school diploma or equivalent.
Customer service experience.
Computer experience.
Knowledge of customer-service principles and processes, including assessing customer needs, meeting service quality standards, and evaluating customer satisfaction.
Ability to use computers and computer systems to enter data or process information.
Ability to communicate with supervisors, peers, subordinates, and people outside the organization.
Ability to obtain, compile, categorize, calculate, audit, or verify information.
Ability to handle complaints, settle disputes, and resolve grievances and conflicts.
Ability to keep relevant knowledge up to date and apply it to the job.
Ability to organize, plan, and prioritize work and perform administrative activities.
Problem-solving and decision-making skills.
Customer and client focus, time management, communication proficiency, teamwork orientation, technical capacity, and multitasking ability.

Responsibilities

Confer with customers by telephone to provide information about prescription claims processing.
Maintain detailed records of customer interactions and transactions, including inquiries, complaints, comments, and actions taken.
Follow up to ensure appropriate changes were made to resolve customer problems.
Refer unresolved customer grievances to designated departments for further investigation.
Review prescription insurance policy terms to determine whether an employer-group claim is covered.
Contact customers to answer inquiries or notify them of investigation results or planned adjustments.
Resolve customer service or billing complaints.
Obtain and examine relevant information to assess complaint validity and possible causes.
Comply with HIPAA obligations related to Protected Health Information.
Report discovered HIPAA violations to the Compliance Officer and/or Human Resources.
Attend, complete, and demonstrate competency in required HIPAA training.
Adapt to changing duties and responsibilities as assigned.