• Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services. • Ensures member satisfaction by providing superior customer service and willingness to help at all times while maintaining a professional demeanor. • Provides quality customer service by applying SCAN Five Service Principles. • Educates members, family, providers and caregivers regarding benefits and plan options. • Accurately explains benefits and plan options in person, via email or telephonically. • Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. • Escalates appropriate member issues to management or other departments as required. • Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance. • Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids. • Takes ownership of the issue, focusing on providing solutions and options for members, as necessary through resolution of member issues. • Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed. • Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention. • Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions. • Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Scan Health Plan operations, as documented in company policies and procedures. • Follows all HIPAA requirements. • Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals. • Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development. • Contributes to team effort by accomplishing related results as needed.