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Member Services Supervisor 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. Being a Member Services Supervisor 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. Additionally, Member Services Supervisor typically reports to a manager. The Member Services Supervisor 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. To be a Member Services Supervisor typically requires 3 years experience in the related area as an individual contributor.
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.