Archived listing. The details below describe a past opening.
Member Services Representative / Healthcare Customer Service Representative Position Summary We are seeking a customer-focused Member Services Representative to provide exceptional support to health plan members. This role serves as the primary point of contact for members, assisting with inquiries related to benefits, eligibility, claims, provider networks, and healthcare coverage. The ideal candidate will possess strong communication skills, healthcare customer service experience, and the ability to navigate multiple systems while maintaining compliance with HIPAA regulations. Key Responsibilities Answer high-volume incoming calls from health plan members in a detail oriented and courteous manner. Provide accurate information regarding benefits, eligibility, claims status, provider networks, and healthcare coverage. Assist members in resolving issues, escalating concerns when appropriate, and ensuring timely follow-up. Explain plan policies, procedures, and available healthcare services in a clear and understandable manner. Document all member interactions accurately within CRM and related systems. Research and resolve member inquiries while maintaining established service levels. Collaborate with internal departments, providers, and claims teams to facilitate issue resolution. Maintain compliance with HIPAA regulations, company policies, and confidentiality requirements. Deliver exceptional customer service while demonstrating patience, empathy, and professionalism. Perform data entry and administrative duties related to member account updates and case documentation. Key Skills Customer Service Inbound Call Center Healthcare Support Insurance Verification Claims Inquiry Resolution Benefits & Eligibility CRM Systems Data Entry HIPAA Compliance Problem Solving Communication Skills Attention to Detail Member Relations Multitasking Qualifications Required 1+ year of customer service experience, preferably in a healthcare, insurance, or call center environment. Strong phone-based customer service and communication skills. Experience handling a high volume of inbound calls. Proficiency with CRM systems and data entry. Strong attention to detail and documentation skills. Ability to multitask and navigate multiple systems simultaneously. Excellent problem-solving and conflict-resolution abilities. Preferred Experience with health plans, medical insurance, eligibility verification, claims processing, or provider services. Bilingual skills (if applicable). Experience working in a healthcare contact center or member services environment.