Member Appeal Liaison
AvMed Health Plans 30 reviews - Miami, FL

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Member Appeal Liaison

Level: K
Reports to: Peggy Jo Kidd

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.

•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.

Informed Judgment
Deductive Reasoning
Inductive Reasoning
Customer Service Skills
Courtesy and helpful demeanor
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
Problem solving
Good Memory
Good Judgment
Reasoning skills
Ability to build relationships
Selflessness/Team player
Self motivator
Committed to something bigger than themselves
Embraces Challenge/Engagement

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

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

About this company
30 reviews
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