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A typical day for a Peoples Health Member Services Representative begins with Representatives taking to their work stations and organizing them and setting up their resources to maximize their success in handling calls. That includes reviewing emails, the intranet, the department's dashboard, and team performance from the previous day. After ensuring preparedness, Representatives log onto the phone system and make themselves available to assist callers.
Some days are busier than others and require you to hit the ground running and handle a lot calls while remaining engaged, empathetic, and helpful to the caller. Often times callers are dealing with health and / or financial issues that add a sense of urgency to their requests, and you have to maintain a balance between advocating for members, and business processes that make the company successful. At all times, the customer is at the center of what you do. On slower days, you follow up on outstanding action items that you routed to other departments, and conduct follow - up calls with members to close out their contact. You're always learning something new and expanding your knowledge of the industry and the population of members we serve. It can be a very rewarding experience.
- The Peoples Health Member Services Representative handles inquiries, concerns, complaints, grievances and appeals in a professional manner by listening to the member and showing respect. When appropriate, the Representative takes action to resolve complaints to ensure member retention and satisfaction by following department guidelines or contacts immediate supervisor for intervention
- Educates members, customers (internal / external) while effectively promoting Peoples Health products, services, and policies on the telephone as well as face - to - face communication
- Acts in accordance with Peoples Health vision and values. Participates and supports development programs, active in staff meetings, and performs company educational offerings as well as demonstrating the willingness to work as a team member when needed for additional tasks to ensure excellent service
- Ensures that supplies are sufficient to perform their duties, maintains equipment in proper place after usage and maintains workspace in an orderly fashion
- Acts as an efficient liaison for the member and effectively documents 100% of their communication in the service module achieving a clear link between subject line, category, sub - category and free text
- As needed, handles requests for transportation to participating providers and return trip requests. Properly utilizes the transportation database. Generates denial letters when needed. When requested, prepares daily schedules for vendors and reporting requirements.
- The Representative must become familiar with standard healthcare concepts, practices, and procedures as they relate to claims adjudication and managed care
- Complete special assignments in an accurate and efficient manner with little intervention from management.
- High School Diploma / GED (or higher)
- Bilingual skills in English and Spanish
- Experience in a call center environment or related customer service field
- Prior healthcare experience
- Basic computer navigation skills with experience in a Windows environment
- Experience with Microsoft Office Suite: Microsoft Excel (enter information, save files, navigate through worksheet), Microsoft Word (create documents), Microsoft Outlook (organize email)
- Experience with Internet - utilize web - based internal applications
- Experience with Microsoft Access (data entry into an existing database, run standard reports)
- Amisys experience
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Keywords: UHG, UHC, M&R, PeoplesHealth, member services representative, call center, healthcare, Amisys