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Supervises a group of member services representatives that address 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 researching more complex questions, investigating the cause of the issue, and responding to members on escalated issues. Assists with hiring, training, ongoing monitoring and QA, performance evaluations and any corrective actions of member services representatives. Requires a high school diploma or its equivalent. Typically reports to a manager. Supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. Thorough knowledge of functional area under supervision. Typically requires 3 years experience in the related area as an individual contributor.
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. Provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Requires a high school diploma or equivalent. Typically reports to a supervisor or manager. Works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. Typically requires 1-3 years of related experience.