Member Services Representative

Job Description

Job Description

SIHO’s Member Services Representatives assist in creating an excellent experience for SIHO’s members and their providers. The primary responsibility of this position is to respond to member’s and providers inquiries. This position mainly responds to telephonic inquiries but may also be responsible for responding to written inquiries and assisting walk-in members. This is a non-exempt position reporting to the Manager of Member Services.

Brief Description of Duties:

- Assist members with navigating their healthcare needs by explaining benefits, solving claim concerns, finding a doctor nearby or being their healthcare advocate

-Comply with regulatory requirements while addressing customer needs which may include complex benefit questions.

- Record details of inquiries, comments, complaints, and transactions.

- Escalate unresolved and pending customer grievances.

- Support teammates as business needs require to ensure the organization is meeting the needs of our members and providers

- Strive for first call resolution while demonstrating SIHO’s dedication to proactively work to resolve members questions and concerns.

- Work with partners in other departments, or to Doctors’ offices to help resolve a customer concern.

- Support your teammates as business needs require to ensure we are meeting the needs of our customers.

- Performs other relevant duties deemed necessary to achieve department and company-wide goals.

Traits we are looking for:

- Trustworthy

- Empathic

- Proactive

- Compassionate

- Good Listener

- Problem Solver

- Communicator Patient

- Personable & Collaborative

Minimum Skills Requirement:

Possess a passion for customer service

Excellent communications (oral and written) and strong listening skills

Experience in healthcare is preferred, but not required

General knowledge and understanding of health insurance

This job calls for strong emotional intelligence to proactively provide solutions, ensuring the member's health and safety

Ability to maintain attendance to support required quality and quantity of work

Professional appearance and presence

Commitment to support and maintain confidentiality in conformance to HIPAA guidelines

Required Education:

High School Diploma and 2 years of Customer service experience

Working experience of Microsoft Office or other comparable software

*All positions are subject to change based on the needs of the business

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.