We are seeking a Member Services Rep. II to join our team in Pearland, Texas, 77584-7298, United States. This role offers a long-term contract employment opportunity within the health industry. As a Member Services Rep. II, you will be responsible for providing concierge service to our members, which includes answering inquiries, making outreach calls, and promoting member retention and growth initiatives.

Responsibilities:

• Provide high-level customer service to callers and make outreach calls to members to provide information regarding health plan policies.
• Resolve inquiries from health plan members, providers, and various customers, surpassing productivity, quality, and service standards.
• Learn and implement software applications to respond to administrative issues related to health plan operations.
• Handle administrative tasks related to claims resolution, premium billing, medical benefit interpretation, organization, and coverage determinations.
• Manage referral inquiries, Prescription Drug inquiries, and enrollment/disenrollment activities.
• Interpret and apply Medicare Policy and Procedures, including but not limited to Late enrollment penalty, low-income subsidy enrollment/disenrollment guidance, Medicare beneficiary protections, and Medicare coverage rules.
• Support chat conversations and make outbound calls to assist with scheduling member appointments and to determine disenrollment reasons.
• Maintain accurate customer credit records and process customer credit applications efficiently.
• Monitor customer accounts and take appropriate action based on account status.
• Utilize communication, documentation, and interpersonal skills to enhance customer service and ensure efficient operations.• Demonstrated proficiency in customer service, with a strong emphasis on delivering quality outcomes
• Excellent communication skills, both written and verbal, to effectively liaise with team members and clients
• Proficiency in documentation and recording information accurately as required by operations
• Proficient in planning, scheduling and managing appointments effectively
• Knowledge of procedures and policies related to member services
• Experience in handling both inbound and outbound calls in a professional manner
• Familiarity with insurance concepts, medical coverage, and billing procedures
• Knowledge of workstation support and ability to troubleshoot basic technical issues
• Experience in managing benefit functions and claim administration
• Understanding of regulation and policy within the insurance industry
• Ability to maintain productivity in a fast-paced environment
• Proficiency in Spanish language will be an added advantage
• Strong interpersonal skills to build and maintain professional relationships
• Experience in conducting surveys and collecting customer feedback
• Familiarity with Medicare policies and procedures
• Must be able to prioritize tasks and manage time effectively
• Ability to work online and familiarity with digital tools for service delivery
• Knowledge of quality assurance practices and ability to uphold high service standards.