Job Description

JOB SUMMARY:
Interacts with customers to provide information in response to inquiries about products and services and to handle and resolve complaints. A strong focus is placed on member retention through relationship building and maintaining superior service standards.

EDUCATIONAL REQUIREMENTS
None Specified

CERTIFICATION & LICENSURE REQUIREMENTS
Insurance Producers - Health w/in 6 months of hire. License required for the state(s) in which assigned Health Alliance office conducts business.

EXPERIENCE REQUIREMENTS
Three (3) years General - Customer Service

SKILLS AND KNOWLEDGE
Strong verbal and written skills geared toward communicating with Medicare beneficiaries demonstrated by communicating by e-mail, phone, letters and in person. Able to project a positive image. Able to deal compassionately with Medicare/Medicaid beneficiaries on a one-on-one basis and focus on their needs through careful listening and patience. Able to perform at a constant pace while taking inbound calls and making outbound calls. Must be able to handle multiple tasks under constant pressure. Microsoft Office skills.

ESSENTIAL FUNCTIONS:

• In compliance with Centers for Medicare & Medicaid Services, Illinois Division of Insurance regulations and Health Alliance guidelines, receives, researches, responds to and documents inquiries from or on behalf of members or prospective members in professional and courteous manner.
• Takes action to resolve customer service, claims or billing complaints partnering with other departments if and when necessary. Follows-up to ensure that appropriate changes were made to resolve customer problem. Refers unresolved grievances to Lead Member Services Representative.
• Qualifies and assigns leads generated by internal marketing efforts to contracted brokers or internal sales associates or induces sales independently.
• Performs administrative tasks including but not limited to assembling mailings, distributing faxes, processing credit card transactions, and filing.
• Conducts outbound call campaigns to existing members.

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