Member Services Representative

*** MUST BE LOCAL TO SPOKANE, WA OR RENTON, WA FOR EQUIPMENT PICKUP**
* Professional Summary

The Member Services Representative serves as a key point of contact for health plan members, providers, and external partners, delivering accurate information and resolving inquiries related to coverage, claims, eligibility, and healthcare services. This role operates in a high-volume call center environment and requires strong communication, critical thinking, and customer service skills to support a diverse population. The representative ensures timely and professional resolution of issues while maintaining compliance with healthcare regulations and organizational standards.

Success in this role requires the ability to navigate complex systems, manage multiple priorities, and provide empathetic, solution-oriented support in a fast-paced, remote or hybrid environment.

Key Responsibilities

+ Respond to a high volume of inbound and outbound calls, addressing inquiries from members, providers, brokers, and other stakeholders in a professional and timely manner.

+ Resolve questions and complaints related to health plan coverage, claims, eligibility, referrals, billing, and provider access.

+ Provide clear and accurate information regarding plan benefits, medical services, and healthcare system navigation.

+ Investigate and resolve member and provider issues by reviewing account details, policies, and applicable guidelines.

+ Document all interactions thoroughly and accurately in internal systems to ensure compliance and continuity of service.

+ Communicate effectively across multiple channels, including phone, written correspondence, and system messaging.

+ De-escalate complex or sensitive situations by demonstrating empathy, active listening, and problem-solving skills.

+ Collaborate with internal departments and external partners to resolve issues and ensure a positive member experience.

+ Maintain confidentiality of all member and plan information in accordance with HIPAA and organizational policies.

+ Meet or exceed performance metrics related to call handling, quality, and customer satisfaction in a structured call center environment.

Qualifications

Required:

+ High School Diploma or GED (must be verifiable)

+ Minimum of 1 year of experience in a high-volume call center environment

+ Prior experience working in a remote or work-from-home setting

+ Strong customer service, communication, and problem-solving skills

+ Ability to handle sensitive information with professionalism and confidentiality

+ Comfortable working in a fast-paced, metric-driven environment

+ Must successfully complete required interview assessments and testing

Preferred:

+ Experience in a healthcare, health plan, or insurance call center environment

+  Experience supporting members with medical coverage, claims, or benefits-related inquiries

+ Experience in other regulated industries (e.g., banking, insurance, credit services)

+ Familiarity with healthcare terminology, insurance processes, and patient/member advocacy

We reserve the right to pay above or below the posted wage based on factors unrelated to sex, race, or any other protected

classification. Eligibility requirements apply to some benefits

and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. This temporary role may be eligible for the following:

+ Medical, dental & vision

+ 401(k)/Roth

+ Insurance (Basic/Supplemental Life & AD&D)

+ Short and long-term disability

+ Health and Dependent Care Spending Accounts (HAS & DCFSA)

+ Transportation benefits

+ Employee Assistance Program

+ Time off/Leave (PTO, Vacation, or Sick Leave)  

Job Type & Location

This is a Contract to Hire position based out of SPOKANE, WA.

Pay and Benefits

The pay range for this position is $20.00 - $21.62/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:  - Medical, dental & vision…