Member Concierge Representative - Apex Health Solutions

Position Summary: Apex Health Solutions is expanding our services by building a member concierge team to assist our client’s health plan members with onboarding processes and questions. This position will be one of the initial points of contact with our client organization membership and shall provide initial onboarding through a disciplined flow of call scripting. Individuals within this team will also be responsible for ongoing outreach on a predetermined cadence to enrich the overall member experience.

Essential Duties and Responsibilities:

• Complies with HIPAA/PHI Regulations.
• Correctly warm transfers callers with complex inquiries to the appropriate client team
• Look for ways to improve and promote quality and member commitment
• Respectfully communicates and collaborates with internal and external stakeholders to enhance 
  relationships and render exceptional service.
• Promotes individual professional growth and development by meeting requirements for 
  mandatory/continuing education and skills competency; supports department-based goals which 
  contribute to the success of the organization.
• Adheres to all Compliance/Program Integrity requirements.
• Places outbound calls to members following scripting tools and call flows in an effort to 
• increase member engagement and provide resolution to onboarding questions.
• Meet or exceed call volume requirements while maintain a superior level of service
• Adheres to schedule and scripting tools ensuring commitment to meeting department and client 
• service levels.
• Clearly documents all interactions with members utilizing technology and desk level procedures 
• to ensure accuracy and completeness.
• Appropriately routes any issue(s) that require additional internal review to the correct 
• department.

• Positive phone demeanor and excellent written and verbal communication skills
• Bilingual – English and Spanish
• Listening and compassion skills to support the challenges of our client’s diverse 
• membership
• Ability to multitask in a fast-paced environment
• Must have a service-oriented mindset and be capable of making members feel valued
• Exemplify strong organizational skills
• Self-motivated teammate with strong attention to detail
• Possess a positive attitude and be willing to work as part of a team
• Proficient computer skills, specifically with Microsoft Office and Windows
• Acute analytical and research abilities to triage issues
• Flexible to work evenings, weekends and/or holidays

• Adaptability - Adapts to changes in the work environment. Manages competing demands. Accepts criticism and feedback. Changes approach or method to best fit the situation.
• Communication - Expresses ideas and thoughts verbally. Expresses ideas and thoughts in written form. Exhibits good listening and comprehension. Keeps others adequately informed. Selects and uses appropriate communication methods.
• Dependability - Responds to requests for service and assistance. Follows instructions, responds to management direction. Takes responsibility for own actions. Commits to doing the best job possible. Keeps commitments. Meets attendance and punctuality guidelines.
• Quality - Demonstrates accuracy and thoroughness. Displays commitment to excellence. Looks for ways to improve and promote quality. Applies feedback to improve performance. Monitors own work to ensure quality.
• Quantity - Meets productivity standards. Completes work in timely manner. Strives to increase productivity. Works quickly. Achieves established goals.
• Teamwork - Balances team and individual responsibilities.  Exhibits objectivity and openness to others' views. Gives and welcomes feedback. Contributes to building a positive team spirit. Puts success of team above own interests.

• Education: High School Diploma or GED; Bachelor’s Degree in a health care related field is 
• preferred
• One (1) year of customer service experience in a call center required; Experience in a health 
• plan or pharmacy call center preferred
• One (1) year of health care, case management or pharmacy experience required

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable 
accommodations may be made to enable individuals with disabilities to perform the essential 
functions. The noise level in the work environment is usually quiet.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the 
essential functions. While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand and walk.

The above job description is not intended to be an all-inclusive list of duties and standards of 
the position. Incumbents will follow any other instructions, and perform any other related duties, 
as assigned by their supervisor.

ABOUT APEX HEALTH SOLUTIONS
Apex Health Solutions powers payers and providers choosing to engage in value-based risk 
contracting. Apex’s unique solutions create alignment between payers and providers, generating 
unparalleled value. Combined with Apex’s experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care.