Skills & Competencies for Member Services Representative

Member Services Representative job profile

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JOB SUMMARY for Member Services Representative

Addresses 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

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

Member Services Representative SALARY RANGE

BASE 50%
$38,513
TOTAL 50%
$38,731
Job Level
A02
Job Code
HC07000290
Education/Degree
High School Diploma or Technical Certificate
Reports To
Supervisor or Manager

Member Services Representative 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 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

1 Job Family Competencies – HIPAA Compliance
Proficiency Level -1
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)
Lists needed requirements for abiding HIPAA compliance in our organization.
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Level 2 Behaviors
(Light Experience)
Records and reports potential security and compliance risks regarding HIPAA Privacy rules.
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Level 3 Behaviors
(Moderate Experience)
Performs investigation of HIPAA incidents to meet government and industry compliance standards.
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Level 4 Behaviors
(Extensive Experience)
Oversees all phases of HIPPA compliance analysis to optimize the organization's enforcement of privacy policies.
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Level 5 Behaviors
(Mastery)
Stays current of new technologies and processes impacting our organization’s HIPPA compliance program.
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2 Job Family Competencies – Healthcare Industry
Proficiency Level -1
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)
Names the healthcare industry sectors and defines the purpose and functions of each.
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Level 2 Behaviors
(Light Experience)
Uses and maintains electronic health records (EHRs) according to legal and industry standards.
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Level 3 Behaviors
(Moderate Experience)
Researches technical developments in the healthcare industry and assesses their implications for our organization.
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Level 4 Behaviors
(Extensive Experience)
Recommends innovations to minimize and control costs in providing quality care to clients.
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Level 5 Behaviors
(Mastery)
Stays abreast of the changes in industry laws to ensure our organization's adherence.
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3 Member Services Representative - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Member Services Representative
Proficiency Level - 4
5 Competency for - Member Services Representative
Proficiency Level - 5

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

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)
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)
Anticipates clients' needs and fulfills them in advance.
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Level 5 Behaviors
(Mastery)
Champions a customer-centric, service excellence culture.
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2 Core Competencies – Attention to Detail
Proficiency Level -2
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)
Performs assigned responsibilities according to standard procedures and standards.
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Level 3 Behaviors
(Moderate Experience)
Implements a variety of cross-checking approaches and mechanisms.
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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 - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Member Services Representative
Proficiency Level - 4
5 Competency for - Member Services Representative
Proficiency Level - 5

Summary of Member Services Representative skills and competencies

There are 0 hard skills for Member Services Representative.
6 general skills for Member Services Representative, HIPAA Compliance, Healthcare Industry, Healthcare Knowledge, etc.
7 soft skills for Member Services Representative, 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, he or she needs to be proficient in Service Excellence, be proficient in Attention to Detail, and be proficient in Confidentiality.

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