Summary of Position -

• The Member Services Representative provides personalized, high-quality service to health plan members by promptly addressing inquiries and resolving concerns.
• This role involves coordinating with management and other departments to ensure member satisfaction, maintaining accurate documentation, and demonstrating a thorough understanding of health insurance operations, including Medicare-related services.

Essential Functions -

• Provide personalized service to members via phone, email, or in-person regarding Enrollment, benefits, eligibility, billing, claims, and authorizations.
• Record all member inquiries and complaints accurately in the tracking system, ensuring timely follow-up and resolution.
• Meet or exceed departmental production and quality standards for all communications.
• Treat all customers with respect, empathy, and professionalism while maintaining a service-oriented attitude.
• Demonstrate working knowledge of health insurance practices, including regulatory rules, benefit structures, and internal systems such as Amisys and Macess.
• Exercise independent judgment and problem-solving skills to address member concerns effectively.
• Communicate clearly and confidently both verbally and in writing.
• Manage time efficiently in a fast-paced call center environment.
• Maintain strict confidentiality of member health and business information.
• Adhere to all company, departmental, and regulatory policies and procedures.

Minimum Qualifications -

Education -

• High School Diploma or GED required.
• College coursework or degree preferred.

Experience & Training -

• Minimum 1+ year of relevant experience in a customer service, call center, or administrative support role.
• Prior experience in Medicare and/or health insurance strongly preferred.

Skills & Competencies -

• Strong understanding of customer service practices, including phone etiquette and documentation workflows.
• Excellent written and verbal communication skills.
• Proficient in Windows and computer-based information management.
• Professional demeanor with a compassionate, customer-first approach.
• Adept at operating standard office equipment (computer, headset, etc.) with strong keyboarding and system navigation skills.
• Knowledge or ability to learn health insurance terminology, governing rules, and compliance regulations.
• Effective organizational, time management, and multitasking abilities.
• Ability to maintain confidentiality and comply with HIPAA standards.
• Flexibility to adjust work hours as needed and comfort working remotely if required.