Job Description

Customer Service Representative

Role Overview

The Member Customer Advocate serves as the primary point of contact for members, providing information on benefits, payments, and enrollments. This role requires professionalism, empathy, and a commitment to resolving member concerns efficiently and accurately.

Key Responsibilities

• Communicate plan policies, procedures, and services to members.
• Maintain performance goals:
• 80% of calls answered within 30 seconds.
• Call abandonment rate under 5%.
• Average hold time under 2 minutes.
• 92%+ quality score after 60 days on the floor.
• Serve as a first-contact resource for benefit and enrollment inquiries.
• Verify and update member demographic information.
• Address member concerns and work toward resolution before escalation.
• Access benefit information systems and accurately document each interaction.

Qualifications

• Education: High School Diploma or GED required.
• Experience: Entry-level; customer service or call center experience preferred.
• Skills:
• Strong communication and phone etiquette.
• Proficiency in typing and basic computer skills.
• Ability to multi-task and perform in a fast-paced environment.
• Problem-solving and customer advocacy mindset.
• Must pass spelling, grammar, and computer skills testing.

Key Success Factors

• Completion of all required training and proficiency testing.
• Adherence to departmental performance and quality metrics.
• Knowledge of company policies, procedures, and product offerings.
• Commitment to providing an exceptional customer experience.

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