Per Diem/Member Service Rep

Details: JOB PURPOSE:Supports organization's 5-Star initiatives by the following: Serves members by being a member advocate and point of contact for members' questions/concerns regarding benefits, eligibility, referrals, claims, and any other aspect of plan benefit/services; and by answering inquiries from providers and internal customers regarding benefit interpretation, eligibility issues, and other related concerns. Ensures member satisfaction by providing superior customer service, projecting a willingness to help at all times while maintaining a professional demeanor.ESSENTIAL JOB RESULTS:Provides excellent customer service by consistently meeting and/or exceeding the departmental standards including but not limited to quality, productivity, adherence to schedule and attendance. Provides quality customer service by applying SCAN's Five Service Principles. Educates members, family, friends, providers and caretakers regarding benefits and plan optionsProvides follow-up with members by clarifying the customer's issue, determining the cause, identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required and following departmental procedures.Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures. Additionally, the MSR takes ownership of the issue, focusing on providing solutions and options for member, as necessary through resolution of member issue.Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.Ability to accurately interpret and explain benefits and plan options successfully in person, via email or telephonically.Increases member satisfaction and retention by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed. Participates in member retention projects as assigned by management to support the overall SCAN goal of membership retention.Follows policies and procedures in order to maintain efficient and compliant operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.Follows all appropriate Federal and State regulatory requirements and guidelines applicable to SCAN Health Plan operations or as documented in company policies and procedures.Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.Contributes to creating and maintaining a positive work environment.Contributes to team effort by accomplishing related results as needed.

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