Member Customer Service Representative

Member Customer Service Representative

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Member Customer Service Representative based in the United States.

This role provides essential customer service support to members and healthcare providers, helping resolve questions accurately and efficiently. You'll handle inbound and outbound interactions while working toward first-call resolution and a positive customer experience. The position combines research, problem-solving, documentation, and clear communication across a high-volume service environment. You'll work with sensitive information and follow established privacy, compliance, and quality standards.

The role also offers exposure to healthcare, insurance, claims, and provider operations. With structured training and opportunities for internal progression, it provides a strong foundation for a career in healthcare operations.

Accountabilities:

• Handle inbound and outbound phone-based customer service interactions, providing accurate information, education, and first-call or email resolution while de-escalating concerns when necessary.
• Research claims status and routine inquiries, investigate issues, and route matters requiring additional review to the appropriate teams.
• Follow up on outstanding or pended items and ensure incoming documentation is directed to the correct departments for completion.
• Thoroughly document member and provider interactions, maintaining accuracy, completeness, timeliness, and compliance with privacy requirements.
• Support both members and healthcare providers, including clinics, hospitals, skilled nursing facilities, and vendors across multiple geographic locations.
• Work consistently against established quality, performance, productivity, and attendance expectations.
• Adapt communication approaches to different audiences while maintaining empathy, professionalism, and respect.
• Handle highly sensitive personal information in accordance with applicable privacy and healthcare compliance requirements.
• Participate in ongoing training, feedback, process improvements, and other duties aligned with the needs of the customer service operation.

• High school diploma or GED required.
• Two years of customer service experience in a related field, with additional consideration for candidates with two years of college coursework or three years of customer service experience.
• Demonstrated ability to resolve customer concerns, manage conflict, and communicate with empathy and professionalism.
• Experience navigating Microsoft Office or comparable software platforms, including working across multiple screens and systems while supporting live calls.
• Ability to receive constructive feedback, adjust working practices, and implement changes that improve performance.
• Strong verbal and written communication skills, with the ability to adapt communication style to a broad range of audiences.
• Ability to work in a high-volume customer service or call center environment with performance metrics and audited work.
• Experience in healthcare, insurance, benefits, claims processing, or related industries is valuable.
• Familiarity with recorded-screen environments and experience handling high volumes of inbound and outbound calls are preferred.
• Ability to work scheduled shifts and maintain reliable attendance and consistent performance.
• Comfortable working with sensitive information while following privacy, security, and compliance requirements.
• Ability to keyboard, communicate clearly by telephone, and perform primarily sedentary work involving occasional handling of items weighing up to approximately 10 pounds.

• Full-time, work-from-home position with a consistent…