Member Appeal Liaison
AvMed Health Plans - Miami, FL

This job posting is no longer available on AvMed Health Plans. Find similar jobs: Member Appeal Liaison jobs - AvMed Health Plans jobs

Member Appeal Liaison

Level: K
Reports to: Peggy Jo Kidd

SCOPE OF POSITION:
The role of the Member Services Liaison is to provide timely resolution of member concerns working with internal departments as well as certain external customers. These departments include but are not limited to; client services, small group support center, provider service center and claims. This position will also provide timely resolution to emails received from outside agents & brokers. Communication will be primarily through email communication, review of Macess EXP mailbox and specific call queue assignment.

This person should perform at a mastery level in essential job functions, functional and behavioral competencies.

ESSENTIAL JOB FUNCTIONS:
•Provide timely accurate research and resolution to member issues in accordance with established procedures.
•Maintain an up to date and thorough knowledge of product offerings and plan guidelines.
•Use negotiating skills when dealing with complex issues or emotional customers.
•Follow all department processes of call handling and documentation in a professional and timely manner.
•Refer unresolved issues to the department manager and/or appropriate area when necessary.
•Focus on achieving departmental and organizational objectives.
•Assist in the call center phone queues during busy times.

FUNCTIONAL COMPETENCIES:
Informed Judgment
Deductive Reasoning
Inductive Reasoning
Customer Service Skills
Empathy
Courtesy and helpful demeanor
Patience
Communication Skills (Verbal and Written)
Vocal skills (inflection, tone, tempo)
Effective listening skills
Clear and concise writing skills
Use of proper grammar and sentence structure
Fast and accurate typing skills
Ability to summarize and document issues while talking to callers
Time Management Skills
Cognitive Ability
Perception
Problem solving
Good Memory
Good Judgment
Reasoning skills
Ability to build relationships
Selflessness/Team player
Initiative
Self motivator
Engaged
Committed to something bigger than themselves
Embraces Challenge/Engagement

BEHAVIORIAL COMPETENCIES
•Collaborative
Manage relationships when difficult circumstances occur and develop a culture of trust both within and outside the team
•Accountable
Understand the need for guidelines/procedures but know when to use good judgment
•Respectful
Towards internal and external customers
•Ethical
Honest and reliable in business practices
•Service driven.
Provide world-class service
Pleasant demeanor
Sense of Urgency

MINIMUM QUALIFICATIONS:
Have mastered a position within Member Services where the essential job function consisted of detailed written and verbal communication.

AvMed Health Plans is a Drug/Tobacco Free Workplace EOE

AvMed Health Plans - 14 months ago - save job - block
About this company
15 reviews