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%
$38,426
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

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)
Explains covered entities to comply with HIPAA Privacy rules and regulations.
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Level 2 Behaviors
(Light Experience)
Follows the set guidelines to inform the employees about rights under the HIPPA act.
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Level 3 Behaviors
(Moderate Experience)
Evaluates changes in HIPAA rules to update and expand policies in alignment with new regulations.
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Level 4 Behaviors
(Extensive Experience)
Establishes a periodic evaluation of the organization's information systems to achieve HIPAA compliance.
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Level 5 Behaviors
(Mastery)
Determines the vision of advanced HIPAA-compliant program to achieve our organization's data privacy and security.
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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)
Describes the history and recent developments in the healthcare industry.
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Level 2 Behaviors
(Light Experience)
Locates resources to acquire updates regarding changes in healthcare regulations and requirements.
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Level 3 Behaviors
(Moderate Experience)
Leverages advanced analytics to improve patient-based service outcomes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates healthcare industry changes and proposes objective and strategy improvements.
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Level 5 Behaviors
(Mastery)
Keeps current on issues concerning information privacy to improve customers' trust in sharing personal information.
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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)
Explains the definition and characteristics of service excellence.
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Level 2 Behaviors
(Light Experience)
Provides timely response to customers' complaints, feedback, and comments.
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Level 3 Behaviors
(Moderate Experience)
Follows through on customers' complicated questions, requests, and complaints.
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Level 4 Behaviors
(Extensive Experience)
Directs service design programs to optimize service delivery and customer experience.
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Level 5 Behaviors
(Mastery)
Explores innovative service models and processes to exceed client expectations.
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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)
Lists the traits of an employee showing great attention to detail.
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Level 2 Behaviors
(Light Experience)
Utilizes specific approaches and tools for checking and cross-checking outputs.
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Level 3 Behaviors
(Moderate Experience)
Uses tools to organize and monitor work progress.
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Level 4 Behaviors
(Extensive Experience)
Manages training to improve staffs' concentration and attention to detail.
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Level 5 Behaviors
(Mastery)
Learns from previous works' strengths and weaknesses to guide new projects.
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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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