Member Service Representative

Accountabilities:

• • Handle inbound member calls and provide accurate, courteous assistance across a broad range of healthcare and membership-related questions.
  • Verify member information and ensure that information provided or collected is accurate and complete.
  • Research, troubleshoot, and resolve member inquiries and issues while creating a seamless service experience.
  • Make outbound calls when necessary to provide updates, resolve outstanding issues, or gather additional information.
  • Maintain consistent communication with members and internal and external stakeholders throughout the resolution process.
  • Escalate complex or unresolved issues to the appropriate level of supervision when required.
  • Maintain accurate member documentation, records, work queues, and timekeeping information.
  • Meet established productivity, quality, service, and queue-management standards.
  • Participate in required training and demonstrate proficiency with applicable systems, processes, and procedures.
  • Navigate multiple systems simultaneously while maintaining accuracy and a high level of customer service.
  • Apply established guidelines and procedures to identify solutions, improve efficiency, and enhance member satisfaction.
  • Perform additional duties and responsibilities as assigned by management.

  Requirements:

  • High school diploma or GED required.
  • At least 2 years of customer service experience in a call center environment.
  • Experience working in a fast-paced customer service or processing environment is preferred.
  • Experience in healthcare or familiarity with medical insurance processes is preferred.
  • An associate degree or higher in a related healthcare field is a plus.
  • Excellent verbal and written communication skills, including strong telephone etiquette and active listening.
  • Strong interpersonal and customer service skills, with the ability to communicate clearly, concisely, and compassionately.
  • Strong attention to detail, organization, multitasking, and record-management abilities.
  • Critical-thinking and problem-solving skills, with the ability to follow established methods while identifying appropriate solutions.
  • Ability to follow direction, organizational policies, procedures, and service standards.
  • Working knowledge of administrative and clerical processes, including word processing and managing files and records.
  • Familiarity with Microsoft Office applications and the ability to learn and navigate multiple software systems simultaneously.
  • Experience with healthcare or electronic medical record systems such as EPIC is beneficial.
  • Ability to work effectively in a remote environment with strong self-motivation, reliability, focus, and time-management skills.
  • Ability to sit and handle telephone calls for extended periods.
  • Ability to lift approximately 10–25 pounds and accommodate occasional travel of up to 25%.

  Benefits:

  • Full-time, 40-hour workweek with a daytime schedule.
  • Fully remote work environment.
  • Opportunity to contribute to a healthcare mission focused on improving the member experience.
  • Structured training and opportunities to develop proficiency in healthcare service processes and systems.
  • Collaborative environment with support from management and peers.
  • Exposure to healthcare membership services, customer support, and issue-resolution processes.
  • Non-exempt position with compensation and benefits determined by applicable employment policies.
  • Workplace accommodations are available for qualified individuals with disabilities.