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%
$51,341
TOTAL 50%
$52,466
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)
Cites the policies and procedures on compliance with the HIPAA Privacy Rule.
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Level 2 Behaviors
(Light Experience)
Adheres to policies and procedures in conducting HIPAA compliance process.
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Level 3 Behaviors
(Moderate Experience)
Analyzes and maintains authorization forms, plan documents, and notices to ensure compliance with HIPAA regulations.
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Level 4 Behaviors
(Extensive Experience)
Adopts documentation platforms to improve security for HIPAA compliance of employees and client-proprietary information.
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Level 5 Behaviors
(Mastery)
Constructs strategic action plans for potential compliance risks with applicable policies from HIPAA 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)
Compiles a list of risks and regulatory challenges for healthcare industries.
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Level 2 Behaviors
(Light Experience)
Assists in implementing industry best practices to secure and protect confidential healthcare information.
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Level 3 Behaviors
(Moderate Experience)
Communicates healthcare policies and procedures to ensure compliance with professional practice standards.
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Level 4 Behaviors
(Extensive Experience)
Delivers healthcare education and training programs to bridge skill gaps in our organization.
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Level 5 Behaviors
(Mastery)
Designs and implements cost-effective strategies to optimize resource utilization within healthcare settings.
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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)
Describes different levels of service that exceed, meet or fall short of expectations.
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Level 2 Behaviors
(Light Experience)
Complies with service agreements entered into with customers or provides early notice of any deviations.
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Level 3 Behaviors
(Moderate Experience)
Communicates with customers to determine whether any problems remain after initial resolution and seek feedback.
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Level 4 Behaviors
(Extensive Experience)
Addresses conflicts or difficulties with customers proactively before problems escalate.
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Level 5 Behaviors
(Mastery)
Adopts the latest Customer Relationship Management (CRM) and Social Customer Relationship Management (SCRM) technologies and tools to improve customer service.
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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)
Cites steps and tips to improve attention to detail in the workplace.
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Level 2 Behaviors
(Light Experience)
Keeps full attention when listening to understand the message.
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Level 3 Behaviors
(Moderate Experience)
Balances between accuracy and efficiency for different tasks or programs.
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Level 4 Behaviors
(Extensive Experience)
Creates and implements quality management processes for our business.
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Level 5 Behaviors
(Mastery)
Defines possible hurdles to projects and creates strategies to deal with them.
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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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