Skills & Competencies for Member Services Representative, Sr.

Member Services Representative, Sr. job profile

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JOB SUMMARY for Member Services Representative, Sr.

Addresses more complex health plan or HMO member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.

JOB RESPONSIBILITIES for Member Services Representative, Sr.

Responsible for receiving, responding to, and directing member phone calls and written requests. Provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines.

Member Services Representative, Sr. SALARY RANGE

BASE 50%
$52,511
TOTAL 50%
$53,664
Job Level
A03
Job Code
HC07000485
Education/Degree
High School Diploma or Technical Certificate
Reports To
Supervisor or Manager

Member Services Representative, Sr. Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Member Services Representative, Sr. skill and competencie below to view definitions.
JOB FAMILY COMPETENCIES CORE COMPETENCIES
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6 general skills or competencies (Job family competencies) for Member Services Representative, Sr.

1 Job Family Competencies – HIPAA Compliance
Proficiency Level -2
Skill definition-Abiding in the act protects sensitive patient health information from being disclosed without the patient's consent and knowledge.
Level 1 Behaviors
(General Familiarity)
Describes the basic functions of tools, technologies, and software used in HIPAA compliance.
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Level 2 Behaviors
(Light Experience)
Carries out internal and external audits to review HIPAA compliance procedures of employees.
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Level 3 Behaviors
(Moderate Experience)
Defines and implements guidelines and protocols to reduce healthcare fraud and abuse.
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Level 4 Behaviors
(Extensive Experience)
Designs and implements standard procedures to rapidly resolve emerging issues in HIPAA compliance.
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Level 5 Behaviors
(Mastery)
Designs a privacy infrastructure to maximize operational controls with HIPAA compliance and associated regulations.
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2 Job Family Competencies – Healthcare Industry
Proficiency Level -2
Skill definition-Applying healthcare industry knowledge to manufacture drugs and equipment and offer clinical and other healthcare-related support services.
Level 1 Behaviors
(General Familiarity)
Describes current systems and scope of services provided by healthcare organizations.
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Level 2 Behaviors
(Light Experience)
Conducts research on existing issues within the healthcare industry and possible solutions.
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Level 3 Behaviors
(Moderate Experience)
Identifies cost-effective solutions to address regulatory compliance challenges in healthcare services.
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Level 4 Behaviors
(Extensive Experience)
Develops a framework that promotes cross-functional cooperation and communication to optimize healthcare service.
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Level 5 Behaviors
(Mastery)
Develops and establishes risk reduction best practices to mitigate security breaches in our healthcare organization.
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3 Member Services Representative, Sr. - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Member Services Representative, Sr.
Proficiency Level - 4
5 Competency for - Member Services Representative, Sr.
Proficiency Level - 5

7 soft skills or competencies (core competencies) for Member Services Representative, Sr.

1 Core Competencies – Service Excellence
Proficiency Level -2
Skill definition-The capability of consistently delivering outstanding customer experiences to meet and even exceed customers' expectations.
Level 1 Behaviors
(General Familiarity)
Emphasizes the importance and value of providing excellent service.
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Level 2 Behaviors
(Light Experience)
Directs customers to the appropriate team or department if predicament cannot be immediately resolved.
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Level 3 Behaviors
(Moderate Experience)
Contributes to a service recovery program to rectify the situation and regain the client's trust.
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Level 4 Behaviors
(Extensive Experience)
Coaches others on superior customer service strategies in diverse situations.
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Level 5 Behaviors
(Mastery)
Defines organizational service excellence vision, mission, and strategy.
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2 Core Competencies – Attention to Detail
Proficiency Level -3
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Explains why attention to detail plays an important role in own function or unit.
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Level 2 Behaviors
(Light Experience)
Performs assigned responsibilities according to standard procedures and standards.
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Level 3 Behaviors
(Moderate Experience)
Processes large quantities of detailed information with high levels of accuracy.
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Level 4 Behaviors
(Extensive Experience)
Demonstrates expertise in quality assurance tools, techniques, and standards.
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Level 5 Behaviors
(Mastery)
Designs techniques for measuring the cost and impact of errors.
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3 Member Services Representative, Sr. - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Member Services Representative, Sr.
Proficiency Level - 4
5 Competency for - Member Services Representative, Sr.
Proficiency Level - 5

Summary of Member Services Representative, Sr. skills and competencies

There are 0 hard skills for Member Services Representative, Sr...
6 general skills for Member Services Representative, Sr., HIPAA Compliance, Healthcare Industry, Healthcare Knowledge, etc.
7 soft skills for Member Services Representative, Sr., Service Excellence, Attention to Detail, Confidentiality, etc.
While the list totals 13 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Member Services Representative, Sr., he or she needs to be proficient in Service Excellence, be skilled in Attention to Detail, and be skilled in Confidentiality.

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