Member Services Representative

Job#: 3036468

Job Description:

The Member Services Representative serves as a primary point of contact for members, delivering high-quality, personalized support across a range of healthcare and insurance-related inquiries. This role is responsible for addressing questions related to enrollment, benefits, eligibility, billing, claims, and authorizations while ensuring a seamless and positive member experience.

Success in this position requires a balance of professionalism, empathy, and strong problem-solving skills in a fast-paced, customer-focused environment. The ideal candidate is detail-oriented, adaptable, and comfortable navigating multiple systems within a highly regulated industry.

Key Responsibilities

* Support members via phone, email, and other communication channels regarding benefits, claims, enrollment, and billing inquiries

* Provide clear, accurate guidance through complex healthcare and insurance processes

* Document all member interactions and ensure appropriate follow-up and resolution

* Collaborate with internal teams to resolve issues and escalate when necessary

* Meet or exceed performance metrics for quality, productivity, and response times

* Apply sound judgment to interpret policies and resolve member concerns

* Maintain working knowledge of healthcare regulations and internal systems

* Handle sensitive situations with empathy, professionalism, and a customer-first approach

* Ensure compliance with confidentiality and data privacy standards

* Manage workload effectively in a fast-paced, high-volume environment

Qualifications

* High School Diploma or GED required; some college preferred

* 2+ years of customer service, call center, or administrative support experience

* Healthcare, Medicare, or health insurance experience strongly preferred

Core Skills

* Strong customer service, communication, and problem-solving abilities

* Ability to navigate multiple systems and tools efficiently

* Detail-oriented with strong organization and time management skills

* Adaptable with the ability to quickly learn new processes and regulations

* Comfortable working in remote or hybrid environments

Work Environment

* Fast-paced, metrics-driven environment

* Prolonged periods of sitting with frequent computer and phone use

* Moderate decision-making requiring independent judgment

* Strict adherence to confidentiality and compliance standards

The Member Services Representative provides personalized, high‑quality support to members by answering questions, resolving concerns, and coordinating with internal teams to ensure a positive service experience. This role requires strong communication skills, attention to detail, and the ability to manage tasks efficiently in a fast‑paced environment. The ideal candidate demonstrates empathy, professionalism, and a strong commitment to customer satisfaction.

Key Responsibilities

* Provide personalized service to members via phone, email, or in person regarding enrollment, benefits, billing, claims, eligibility, and authorization inquiries.

* Accurately document all member interactions, inquiries, and complaints in the tracking system and route items appropriately for follow‑up.

* Consistently meet or exceed departmental productivity, accuracy, and quality standards.

* Demonstrate a customer‑first mindset with empathy, active listening, and professional communication.

* Maintain working knowledge of health insurance guidelines, regulations, and internal systems.

* Use independent judgment and problem‑solving skills to resolve issues and interpret procedures.

* Maintain confidentiality of all member and business information in compliance with company and regulatory standards.

* Effectively manage time and workload in a high‑volume, fast‑paced call‑center environment.

Minimum Qualifications

Education

* High school diploma or GED required.

* Some college coursework preferred.

Experience

* At least 1 year of customer service experience, preferably in:

* A call center environment

* Administrative support

* Medicare or health insurance-related roles

Skills & Competencies

* Strong verbal and written communication skills.

* Knowledge of customer service best practices and phone system operations.

*…