Job Overview
Compensation
Hourly
Range $12.00 - $19.00
Benefits
Health Insurance
Dental Insurance
Paid Time Off
Retirement Plan
Employee assistance program
Training and Development
flexible schedule
Job Description
SummaCare is a respected health insurance company committed to providing high-quality, personalized healthcare solutions to its members. With a strong dedication to customer service, SummaCare focuses on supporting the diverse needs of its members by offering comprehensive health plans, accessible resources, and a responsive support system tailored to improve overall member satisfaction and health outcomes. As a key player in the healthcare insurance industry, SummaCare strives to maintain a culture of integrity, respect, and empowerment, which extends through every level of its operation and customer interaction.
The Member Services Representative role at SummaCare is pivotal in fostering positive relationships with members by delivering exceptional customer service and timely resolution of inquiries and concerns. This position involves providing personalized service to members and other SummaCare customers through multiple communication channels, including phone and electronic correspondence. The representative addresses questions related to enrollment, benefits, eligibility, billing, claims, and authorizations with accuracy and empathy. This role requires a professional demeanor combined with a warm, customer-first attitude to effectively manage and resolve member issues.
Functioning within a fast-paced, dynamic work environment, the Member Services Representative is expected to meet or exceed departmental production and quality standards. The position involves detailed record-keeping using company tracking systems, requiring the accurate documentation of member inquiries and complaints, and ensuring appropriate routing for resolution. Additionally, the role demands knowledge of health insurance industry regulations, company policies, and systems such as Plan Central and Macess to effectively support members' needs.
Working in this role entails exercising independent judgment and decision-making skills within the scope of established procedures. The representative must also balance multiple tasks simultaneously while maintaining close attention to detail and adhering to sometimes demanding quotas. A high level of confidentiality is crucial due to handling sensitive member health and business information. The role requires physical tasks such as prolonged sitting, light lifting, and manual dexterity to operate office equipment, supporting the efficiency and accuracy of service delivery.
The Member Services Representative position is ideal for individuals who have prior customer service experience, particularly in health insurance or healthcare-related industries, and who possess effective communication skills both verbal and written. Candidates should be flexible, able to adapt to changing work hours to meet business demands, and demonstrate the ability to learn and apply relevant industry knowledge continually. By joining SummaCare, representatives become part of a supportive team dedicated to making a meaningful difference in the healthcare journey of every member they serve.
The Member Services Representative role at SummaCare is pivotal in fostering positive relationships with members by delivering exceptional customer service and timely resolution of inquiries and concerns. This position involves providing personalized service to members and other SummaCare customers through multiple communication channels, including phone and electronic correspondence. The representative addresses questions related to enrollment, benefits, eligibility, billing, claims, and authorizations with accuracy and empathy. This role requires a professional demeanor combined with a warm, customer-first attitude to effectively manage and resolve member issues.
Functioning within a fast-paced, dynamic work environment, the Member Services Representative is expected to meet or exceed departmental production and quality standards. The position involves detailed record-keeping using company tracking systems, requiring the accurate documentation of member inquiries and complaints, and ensuring appropriate routing for resolution. Additionally, the role demands knowledge of health insurance industry regulations, company policies, and systems such as Plan Central and Macess to effectively support members' needs.
Working in this role entails exercising independent judgment and decision-making skills within the scope of established procedures. The representative must also balance multiple tasks simultaneously while maintaining close attention to detail and adhering to sometimes demanding quotas. A high level of confidentiality is crucial due to handling sensitive member health and business information. The role requires physical tasks such as prolonged sitting, light lifting, and manual dexterity to operate office equipment, supporting the efficiency and accuracy of service delivery.
The Member Services Representative position is ideal for individuals who have prior customer service experience, particularly in health insurance or healthcare-related industries, and who possess effective communication skills both verbal and written. Candidates should be flexible, able to adapt to changing work hours to meet business demands, and demonstrate the ability to learn and apply relevant industry knowledge continually. By joining SummaCare, representatives become part of a supportive team dedicated to making a meaningful difference in the healthcare journey of every member they serve.
Job Requirements
- High school diploma or equivalent
- Minimum of one year performing similar responsibilities
- Prior customer service experience including call center, receptionist, or administrative support with customer responsibilities
- Preferred experience in health insurance or healthcare
- Knowledge of member services practices
- Effective written and verbal communication
- Proficiency in Windows and computer-based information management
- Ability to maintain confidentiality
- Ability to work under moderate stress and multitask
- Physical ability to sit, bend, stoop, lift up to 20 pounds, and operate office equipment
Job Qualifications
- High school diploma or equivalent
- Minimum one year of customer service experience in information management or similar roles
- Effective verbal and written communication skills
- Knowledge of Member Services practices
- Ability to learn health insurance industry rules and regulations
- Proficiency with Windows and standard office machines
- Demonstrated ability to manage time and prioritize tasks in a fast-paced environment
- Ability to maintain confidentiality of health and business information
- Flexible and adaptable to changing work hours
Job Duties
- Provide personalized service to members by phone or electronically regarding enrollment, benefits, eligibility, billing, claims, and authorizations
- Record all member inquiries and complaints in tracking system and route appropriately for resolution
- Meet or exceed departmental production and quality standards for telephonic and written communication
- Treat all members with respect and utilize empathy, education, and empowerment in communications
- Maintain and demonstrate knowledge of Plan Central and Macess systems to resolve customer inquiries
- Perform all job functions with integrity and provide timely internal and external customer service
- Exercise independent judgment, decision-making, and problem solving according to task demands
- Handle moderate stress by concentrating on detail, performing multiple tasks, and meeting quotas
Job Criteria
Experience
No experience required
Job Location
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