REMOTE Member Service Representative; LIVE IN Massachusetts

Member Services Representative I / II – Massachusetts Residents Pay Range: $18–$25 per hour, depending on experience Location Requirement:
Must reside in Massachusetts Language:
English proficiency required;
English/Spanish bilingual skills preferred

We are seeking customer-focused Member Services Representatives to support healthcare and member service programs. Representatives respond to inquiries, explain program information, assist with accessing services, and help resolve member concerns while providing professional, accurate, and timely customer service. Opportunities are available for candidates with varying levels of relevant experience. Assignment at the Representative I or II level will depend on experience, qualifications, and program needs.

More experienced representatives may support multiple programs, handle complex inquiries, and assist with training or team support.

Handle inbound calls and outbound follow-up to assist members, customers, providers, and other callers. Provide information about program requirements, benefits, available services, and resources according to established guidelines. Research questions and concerns using multiple systems, databases, and reference materials. Resolve inquiries within the scope of the role and escape issues requiring additional assistance. Accurately document interactions, actions taken, and follow-up needs.

Coordinate with internal teams and external contacts, as needed, to support timely resolution of member issues. Demonstrate active listening, empathy, clear communication, and professionalism when assisting diverse populations. Meet established expectations for attendance, schedule adherence, service quality, accuracy, and productivity. Participate in required training, team meetings, and quality improvement activities. Protect confidential member and business information in accordance with HIPAA and applicable organizational and program policies.

Depending on the assignment, Representative II responsibilities may include:
Handle escalated or more complex inquiries requiring additional research and coordination. Support multiple programs and apply program-specific procedures accurately. Assist with claims or billing-related inquiries and reconciliation activities, as applicable. Provide guidance, mentoring, or on-the-job support to other representatives. Assist with program updates, system testing, process improvements, and training materials.

Relevant experience in customer service, member services, a contact center, information and referral, or a related service role. Healthcare, health insurance, benefits, or human services experience preferred. Candidates with transferable customer service experience are encouraged to apply for Representative I opportunities. Representative II candidates should demonstrate experience independently resolving more complex inquiries, navigating multiple systems, or supporting healthcare or member service programs.

Relevant college coursework, certifications, or additional education preferred. Ability to read, write, and communicate clearly in English. Bilingual English/Spanish proficiency preferred; language requirements may vary by assignment. Must reside in Massachusetts and reliably work the assigned schedule. Scheduling needs may include evenings, weekends, or holidays, depending on the program.

Strong customer service, active listening, and interpersonal skills. Sound judgment, attention to detail, and effective problem-solving abilities. Ability to learn program information, follow procedures, and navigate multiple computer systems. Strong organizational skills and the ability to manage calls, documentation, and follow-up tasks. Accurate typing and data entry skills, with a target proficiency of at least 30 words per minute. Basic proficiency with internet browsers, Microsoft Outlook, Word, and Excel.

#ZRPROF