Medicare Advantage Member Services Representative

Job Description

Job Title: Medicare Advantage Member Services Representative

Reports To: Manager, MyTruAdvantage Customer Service

Location Requirement:

SIHO’s Member Services Representatives assist in creating an excellent experience for SIHO’s members and their providers. The primary responsibility of this position is to respond to member’s and providers inquiries. This position mainly responds to telephonic inquiries but may also be responsible for responding to written inquiries and assisting walk-in members. This is a non-exempt position.

Brief Description of Duties:

- Assist members with navigating their healthcare needs by explaining benefits, solving claim concerns, finding a doctor nearby or being their healthcare advocate

- Comply with regulatory requirements while addressing customer needs which may include complex benefit questions.

- Record details of inquiries, comments, complaints, and transactions.

- Escalate unresolved and pending customer grievances.

- Support teammates as business needs require to ensure the organization is meeting the needs of our members and providers

- Strive for first call resolution while demonstrating SIHO’s dedication to proactively work to resolve members questions and concerns.

- Work with partners in other departments, or to Doctors’ offices to help resolve a customer concern.

- Support your teammates as business needs require to ensure we are meeting the needs of our customers.

- Performs other relevant duties deemed necessary to achieve department and company-wide goals.

Traits we are looking for:

- Trustworthy

- Empathic

- Proactive

- Compassionate

- Good Listener

- Problem Solver

- Communicator Patient Personable & Collaborative

Schedule & Work Environment:

Full-time position with hybrid work arrangement after training (3 days in office, 2 days remote)

Annual schedule divided into two seasons:

Peak Season (October 1 - March 31)

Team coverage required 7 days/week, 8am-9pm

Available shifts: 8am-5pm, 9am-6pm, 12pm-9pm (remote), and 10am-7pm as needed

Weekend requirement: Minimum 2 weekends per month (remote shifts 12pm-9pm or 10am-7pm)

Schedules provided one month in advance with consideration for employee preferences

Off-Peak Season (April 1 - September 30)

Monday-Friday coverage between 8am-9pm

Available shifts: 8am-5pm, 9am-6pm, or 12pm-9pm (remote)

Must work one late shift per week (either 9am-6pm or 12pm-9pm)

Note: This position supports Medicare Advantage/MyTruAdvantage products, requiring weekend availability during peak season to ensure continuous member support.

Minimum Skills Requirement:

- Possess a passion for customer service

- Excellent communications (oral and written) and strong listening skills

- General knowledge and understanding of health insurance

- Knowledge of Medicare Advantage is preferred, but not required

- This job calls for strong emotional intelligence to proactively provide solutions, ensuring the member's health and safety

- Ability to maintain attendance to support required quality and quantity of work

- Professional appearance and presence

- Commitment to support and maintain confidentiality in conformance to HIPAA guidelines

Required Education:

High School Diploma and 2 years of Customer service experience

- Working experience of Microsoft Office or other comparable software

Other Requirements for Internal Applicants:

Must be in current position with SIHO for at least one year.

- Must not have been on any type of performance management or warning within the last 6 months.

- Has demonstrated an excellent attendance record.

- This position requires some evening shifts as late as 9:00 pm with the possibility of weekends.*All positions are subject to change based on the needs of the business

*All positions are subject to change based on the needs of the business

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Full-time

Hybrid remote