Member Services Representative Lead

Lead Member Services Representative

We're on the lookout for a passionate and dedicated individual who are ready to contribute to our mission of providing essential benefits and services that promote the health and well-being of our members. As a Lead Member Services Representative, you will support our company's customer service activities by directing and overseeing team members, resolving customers questions or complaints, and developing program and procedures to enhance productivity and performance.

Key Responsibilities:

• Trains new employees in the company's customer service policies, procedures, and best practices.
• Organizes and oversees the schedules and work of assigned staff.
• Conducts performance evaluations that are timely and constructive.
• Handles discipline and termination of employees with manager as needed and in accordance with company policy.
• Monitors or reviews calls or other correspondence between representatives and customers.
• Ensures that representatives are informed about changes to company products and services.
• Collects data and prepares reports on customer complaints and inquiries.
• Prepares monthly reports summarizing the assigned customer service team's performance.
• Identifies opportunities to update or improve customer service procedures and makes recommendations to the Director of Customer Service or other appropriate staff.
• Assists callers on inquiries regarding coverage decisions, grievances, appeals, benefit interpretation, eligibility verification, medical group/PCP, explanation of how the plan works and how to utilize services, assists with information regarding referrals or authorizations, member complaints, identification card requests.
• Responsible for maintaining customer service levels (abandonment rate, speed of answer and service level) within established parameters.
• Knowledge on plans benefit, CMS and Plans policies and procedure.
• Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
• Ensures compliance with all HIPAA, OSHA, and other federal, state and local regulations.
• Participates in meetings, trainings, and in-service education, as required.
• Interacts with other departments about member issues or concerns.

Qualifications:

• Bachelor's degree preferred.
• At least three years of customer service experience required.
• Previous experience in a supervisory role preferred.

Performance Measurements:

• 3-5 Monthly evaluations.
• Compliance with Department Call Metrics/ Company Regulations.
• Attendance/Punctuality.
• Safety and Security.
• Quality of work.

What Sets Us Apart:

Join Solis Health Plans as a Lead Member Services Representative and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!