A Member Services Representative renders support and services to the membership-based organization’s clients. A well-drafted Member Services Representative Resume indicates the following duties – responding to requests and complaints; making sales, processing orders, providing information about the organization and its related services; responding instantly to the needs and concerns of the clients; investigating and resolving complaints and concerns; processing transactions; recommending and cross-selling products and services; and escalating unresolved issues to higher authorities or members.
Those seeking to work in this area of work should focus on the following – excellent verbal and written communication skills; strong interpersonal skills; basic personal computer skills, prior sales experience, familiarity with saving and checking products, customer service skills and bilingual speaking skills. A high school diploma or GED is the necessary requirement. However, advanced education will be helpful.
Objective : An aspiring team worker, hardworking, and dedicated individual who wants to meet the challenges posed in the industry and to contribute towards the growth of the organization along with self-motivation. Seeking new challenges in a progressive organization with opportunities for advancement.
Skills : Microsoft; Word, Excel, PowerPoint, Access, National Customer Service Certified
Description :
Educated members and providers on health plan initiatives during telephone conversations.
Maintained performance and quality standards based on established call center metrics including turn-around times.
Reported on membership trends, marketing effectiveness and member feedback to the executive director.
Improved call center functionality and service capacity by resolving customer complaints efficiently and quickly.
Performs a broad variety of duties to service customers on the banking floor and to promote and cross-sell bank services.
Takes and prepares consumer and home equity loan applications, reviewing the credit report for further cross-selling opportunities.
Provided clear and concise answers to member questions and inquiries to ensure quality customer experience.
Experience
0-2 Years
Level
Entry Level
Education
Marketing
Member Services Representative I Resume
Objective : To provide superior customer service while being as friendly and helpful as possible. Meet the needs of the customer and assist them in any questions they might have. Looking to join a suitable organization that rewards hard work and offers good opportunities for career development.
Answer incoming calls from pharmacies, physicians, & members of Medicaid, Medicare, Va, worker's compensation & the public sector.
Actively listen to the caller, determine the reason for the call, & document information in the system.
Assist callers with inquiries regarding benefits, such as eligibility, copay, deductible, formulary, etc.
Assist members with mail order requests, such as new registration, prescription refills, order status, etc.
Accommodate mail order billing issues, including invoice inquiries, past due balance, credit card payment.
Troubleshoot rejected insurance claims and advise the caller of resolution for paid claims.
Coordinate internal resolution of claims exceptions, including possible overrides.
Assist physician's offices with determining if the medication requires prior authorization, or has plan limitations.
Experience
2-5 Years
Level
Executive
Education
Computer Networking
Lead Member Services Representative Resume
Summary : Self-motivated sales professional with over 8 years of management, training, and customer service experience. Possess excellent strategic planning and relationship management skills to expand customer brand awareness and improve retention. In addition to proven track record in successfully introducing new products into a competitive market with the ever-changing needs of both our business and customers.
Skills : Microsoft Office, Excel, Word, Outlook, Customer Service, Customer Relationship Management
Description :
Essential duties and responsibilities is to greet members, prospective members, and guests, providing exceptional customer service.
Advised clients on products that would best suit their needs responded to clients regarding account information; performed problem resolution.
Respond to member questions and concerns in a timely and professional manner and elevate to assistant manager or manager as needed.
Assisted providers, Medicaid and Medicare members on benefits issues, claims inquiries, and eligibility verifications.
Provided customer service to all inbound calls as well as making outbound/outreach calls daily.
Assist members and other departments to research errors and member issues.
Comfort providing customer service with clients over the phone handling multi-line phone operation in a call center environment.
Experience
7-10 Years
Level
Management
Education
Computer Science
Member Services Representative II Resume
Summary : To contribute my enthusiastic personality and excellent clerical skills for medical records or related position in a clinical setting Qualifications. Over 15 years of experience providing quality customer service and excellent relationship building and leadership abilities. Effective problem identification resolution skills.
Skills : Medical Coding, Goverment Claims Processing, Denial Management, Patient Access, Medical Terminology, Medical Billing Exp, Claims Adjuster, Pharmacy Techician
Description :
Currently acting as a liaison between the Medicare member services department and pharmacy services department.
Assisting with pharmacy-related escalations that require significant research, often out of the scope of knowledge for an MSR.
Actively assisting with providing pharmacy training to a newly hired class of representatives.
Actively assisting with drafting communications to be the sent to the entire department regarding changes/improvements to pharmacy processes.
Contact various ipa's on the members' behalf to check the status of referrals and authorizations.
Work directly with provider relations to ensure that providers reflect active eligibility on all platforms.
Perform manual updates on all platforms to ensure claims are properly paid.
Curated and lead up training for various topics for the department in order to increase agent knowledge and productivity.
Traveled to different affiliated offices within the organization to be uptrained on different products and system enhancements.
Experience
10+ Years
Level
Senior
Education
Diploma
Business Member Services Representative Resume
Objective : To utilize my skills and experience in Collections and Medical Billing and Insurance coding in the Health Care Industry, giving me an opportunity for growth and advancement. 3+ years of customer service experience, passionate about quality customer service,
Skills : Microsoft Office, Management, Customer Service Representative, Janitorial, Excel, Power point, Word, Aircraft Towing, Forklift Operator.
Description :
Developed and maintained relationships and negotiations with vendors, Costco managers, and related departments, for the benefit of the members' resolution.
Resolved outcomes for members, & issued compensations necessary due to the resolutions.
Drafted correspondence to members/vendors regularly, and kept copies of all correspondences for Costco files, and members records.
Coordinated relocations for traveling members discontent with their accommodations or resort experience.
Determined and coordinated pricing adjustments in these scenarios, including monetary resolutions on revolving files.
Proactively handled member needs with the highest level of customer service.
Maintained vault and cash drawer and conducted all teller transactions for members.
Experience
0-2 Years
Level
Junior
Education
Sociology
Member Services Representative II Resume
Summary : Over 9 years of responsible corporate experience as an Administrative/ Front Office assistant with experience in customer relations, scheduling,and general office operations. Strong organizational abilities combined with excellent interpersonal, and communication skills that allow me to work effectively with other people at all levels.
Skills : High Customer Service Standards, Working Knowledge Of Microsoft Word And Excel, Has Excellent Verbal And Written Communication .
Description :
Described products to members and accurately explained details and care of merchandise.
Answered product questions with up-to-date knowledge of credit union products and promotions.
Effectively communicated with and supported administrative team on a daily basis.
Developed a reputation as an efficient member services representative with high levels of accuracy.
Investigated and resolved member inquiries and complaints in a timely and empathetic manner.
Ensured superior customer experience by addressing member concerns, demonstrating empathy and resolving problems on the spot.
Built long-term relationships and advised members on purchases and promotions.
Assisting supervisor and manager with taking calls escalated from another rep.
Experience
7-10 Years
Level
Management
Education
Medical Assistant
Lead Member Services Representative Resume
Headline : Dedicated professional with a proven track record in managing multiple, concurrent projects with strong problem solving and follow-through capabilities. Demonstrated ability to work under pressure and meet tight deadlines. Effective leadership, critical thinking, problem solving and interpersonal skills.
Skills : Customer Service, Microsoft Office Programs, Academic Research, Social Media Marketing
Description :
Handles phone calls which will vary from problems and complaints to inquiries and questions for all aspects of the business and will originate from various sources including the members, doctor's offices, hospital offices, and outside vendors.
Evaluates phone calls for possible forwarding to the supervisor depending on the nature of the call.
Makes suggestions to members for more efficient services available to them through the use of more compatible doctor offices, hospitals, pharmacies, dentists and/or vision centers.
Exerts best effort to retain members who are calling to dis-enroll from membership.
Communicates effectively with other staff members in the resolution of problem, complaint and inquiry phone calls.
Enters appropriate data in various computer programs in an efficient and accurate manner.
Verifying insurance for doctor offices and hospitals, provider calls referrals and authorization status and claims.
Maintained customer records, data, and files for retention and other administrative duties.
Experience
5-7 Years
Level
Consultant
Education
Diploma
Member Services Representative Resume
Objective : Guest Relations Customer Service Professional with a true desire to satisfy the needs of others in a fast pace environment, 3 years of customer service experience, successful with conflict resolution in a professional manner, consistent quality assurance recognition, and perfect attendance.
Skills : Proficient In Microsoft Windows, Claims Administration System,telphone, Fax Machines, Kiosk, Carelink, And Matrix Systems.
Description :
Utilized the experience and developed communication skills, to explain confusing and complicated topics in a manner that allows for complete understanding.
Answering inbound calls, using experience in customer service and sound listening skills, choose the effective scripting quickly for excellent member service.
Fraud detection representative o exercised discretion and good judgment while making sound business decisions and analyzing system records in very limited time.
Handle product inquiries, while maintaining company standards and ensuring member satisfaction.
Utilized effective communications to explain confusing and complicated topics in a clear and concise manner.
Verified account activity and take appropriate action to minimize potential fraud loss and member inconvenience while maintaining call control.
Extensive research and documentation of every call to follow-up on customer inquiries.
Experience
2-5 Years
Level
Executive
Education
Medical Billing
Member Services Representative Resume
Summary : Looking forward towards a responsible position where can effectively utilize skills from prior experience, while enhancing my knowledge and enabling me to make a positive and productive contribution in a long term career. Acknowledged for accuracy and efficiency as a Data Entry Clerk.
Manage member care expenditures such as medical supplies, nurse's services, and social worker visits.
Resolved member care issues, problems, and concerns provided accurate and timely response to a high volume of member and prospective member calls.
Assist supervisor with the special project including member acquisitions and payment authorization.
Assisted leadership personnel in the mentoring and skill building of new employees.
Participated in various escalation projects under leadership supervision and direction.
Gathered and verified all required customer information for tracking purposes.
Referred unresolved customer grievances to designated departments for further investigation.
Provided accurate and appropriate information in response to customer inquiries.
Experience
10+ Years
Level
Senior
Education
Bachelor of Science
Member Services Representative Resume
Summary : Enthusiastic professional, with expertise in inventory control and project coordination. Excellent team player with proven ability to multitask and capacity build. Extensive background in customer satisfaction, planning and evaluations, coaching, and communication.
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