Also referred to as: Health Plan Member Services Senior Representative, Health Plan Member Support Senior Representative
Requirements and Responsibilities

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. Responsible for receiving, responding to, and directing member phone calls and written requests. Being a Member Services Representative, Sr. provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative, Sr. requires a high school diploma or its equivalent. Typically reports to a supervisor or manager. The Member Services Representative, Sr. has gained proficiency in multiple competencies relevant to the job. Works independently within established procedures associated with the specific job function. To be a Member Services Representative, Sr. typically requires 3-5 years of related experience.

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