Member Services Representative
Common Ground Healthcare Cooperative (CGHC) is a nonprofit, community-owned health insurance company well positioned to grow into a major force for positive change in the Wisconsin health insurance market. We are a member-governed cooperative with a mission to provide affordable, innovative health insurance solutions to small businesses, non-profits and individuals in Wisconsin. CGHC is looking for a Member Services Representative who believes in our mission, is comfortable working in an exciting, fast-paced environment and who is compatible with our team of hardworking, fun and committed staff.
The Member Services Representative is primarily responsible for maintaining effective customer service for all Common Ground Healthcare Cooperative (CGHC) members and stakeholders by utilizing excellent, in-depth knowledge of company products and procedures. This position will assist members and stakeholders in the areas of enrollment, premium payment, invoicing, benefits and claims. The Representative maintains customer satisfaction by using problem-solving skills and resolving issues for stakeholders. Customer service will be mainly provided via telephone but also may be provided in-person from time to time.
- Ability to maintain patient, employee, and proprietary confidentiality required.
- Ability to consistently meet or exceed customer expectations in performing own work required.
- Ability to use effective customer service techniques and effective interpersonal skills required.
- Ability to act professionally and remain calm in stressful situations required.
- Ability to communicate effectively in-person and in all forms of communication required.
- Ability to work and problem solve independently as well as an integral part of a team required.
- Ability to pay attention to detail required
- Ability to be flexible and adapt to changing situations required.
Essential Duties and Responsibilities
- Follows operating procedures and practices to ensure the highest level of patient/member safety and care.
- Answers telephone calls, consults and assists members and stakeholders in the areas of enrollment, premium payment, invoicing, benefits and claims.
- Problem solves independently to assist members and stakeholders with questions and/or concerns; requests supervisory assistance when needed.
- Documents all calls in accordance with operating procedures.
- Performs in accordance of the Member Service’s call volume goals and quality measurements.
- Maintains company information and patient information in accordance with HIPAA requirements.
- Performs other duties as assigned.
Knowledge and Skills Requirements
- High School graduation or equivalent required. Bachelor’s degree from an accredited college or university with emphasis in marketing, sales, insurance, or health related or communication studies a plus.
- Minimum of two (2) years of health insurance customer service experience required; medical claims experience a plus.
- Effective ability to ensure a high level of customer satisfaction. Ability to be culturally sensitive and work with diverse populations.
- Must be able to use a professional manner to deal courteously and effectively with members and other stakeholders.
- Ability to identify and resolve customer issues by utilizing excellent CGHC product and process knowledge.
- Knowledge of and proven proficiency using personal computers including the use of Microsoft Office applications required. Ability to learn and use an insurance system required. Accurate data entry skills required.
- Outstanding verbal and written communication skills including ability to provide telephone support and consultation.
- Ability to recommend improvements in procedures, materials, and products in order to prevent future member or other stakeholder concerns
- Must use good judgment and have the ability to act decisively at the right time. Ability to “think on feet.”
- Effective ability to ensure a high level of customer satisfaction. Effective interpersonal skills. Ability to be culturally sensitive and work with diverse populations. Professional manner to deal courteously and effectively with members and other stakeholders.
- Ability to maintain confidentiality regarding company information acquired on the job required. Knowledge of or ability to learn HIPAA requirements.
- Ability to work flexible hours as needed required.
- Ability to have transportation available.
- Maintains attendance and punctuality according to Company standards
- Adheres to Company policies and procedures
- Ability to treat others with dignity, respect, and courtesy
- Ability to maintain patient, employee, and proprietary confidentiality
- Ability to communicate effectively in-person and in all forms of communication
- Ability to provide professional image and act professionally
- Ability to be flexible and adapt to changing situations
- Ability to consistently meet or exceed member expectations in performing own work, and to follow operating procedures and practices to ensure the highest level of patient/ member safety and care
- Ability to use effective customer service techniques and effective interpersonal skills required
- Ability to learn new information and integrate processes
Join a winning team of committed professionals in a growing enterprise. Qualified applicants should send their cover letter, resume and salary requirements to firstname.lastname@example.org or Common Ground Healthcare Cooperative, Attn: Human Resources, 120 Bishop’s Way, Suite 150, Brookfield, WI 53005.