Healthcare Member Services Representative

Job Description

We are looking for a Healthcare Member Services Representative to provide professional and compassionate customer support to healthcare members. The role involves assisting customers with healthcare-related inquiries, explaining benefits and coverage, resolving concerns, and ensuring a positive member experience.

Key Responsibilities

• Handle inbound calls and customer inquiries regarding healthcare services, benefits, eligibility, claims, and coverage.
• Provide accurate and easy-to-understand information while maintaining professionalism and empathy.
• Assist members with account-related concerns, provider information, billing questions, and service requests.
• Research and resolve customer concerns efficiently while following established procedures and healthcare guidelines.
• Document customer interactions, inquiries, and resolutions accurately in the system.
• Coordinate with internal teams and healthcare providers when necessary to resolve complex concerns.
• Protect confidential member information and follow applicable privacy and security policies.
• Meet established quality, productivity, attendance, and customer satisfaction standards.
• Maintain a professional and courteous approach when handling difficult or sensitive customer situations.
• Stay updated on healthcare plans, policies, procedures, and available services.
  
  

• High school diploma, senior high school diploma, or equivalent.
• Previous customer service, call center, BPO, healthcare, or medical account experience is an advantage.
• Excellent verbal and written communication skills.
• Strong listening, problem-solving, and multitasking abilities.
• Comfortable using computers and navigating multiple systems.
• Willing to work on shifting schedules, weekends, and holidays when required.
• Able to handle sensitive customer information with confidentiality and professionalism.