Member Services Representative addresses 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, or written questions. Being a Member Services Representative provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Member Services Representative works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Member Services Representative typically requires 1-3 years of related experience.
Member Experience Specialist administers and implements programs and initiatives to engage current and new members and continuously improve the member experience. Solicits member feedback and presents findings to internal teams to identify improvement goals to meet member needs, resolve problems, and generate new ideas for programs or services. Being a Member Experience Specialist coordinates with internal stakeholders to access the resources and facilitate processes to support programs that deliver consistent member satisfaction. Utilizes web or social media to promote the organization, collect data on member sentiments, and communicate with members. Additionally, Member Experience Specialist typically requires a bachelor's degree. Typically reports to a manager. The Member Experience Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Member Experience Specialist typically requires 2-4 years of related experience.
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 equivalent. Typically reports to a supervisor or manager. The Member Services Representative, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Member Services Representative, Sr. typically requires 3-5 years of related experience.
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