Skills & Competencies for Member Services Representative
Member Services Representative job profile
Book a Demo and Receive a Sample Job ProfileJOB 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%
$38,426
TOTAL 50%
$38,640
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
6 general skills or competencies (Job family competencies) for Member Services Representative
1
Job Family Competencies –
HIPAA Compliance
Proficiency Level -1
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 -1
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
- 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
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)
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
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)
Implements a variety of cross-checking approaches and mechanisms.
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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
- 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.
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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