Job Description
Member Services Representative Responsibilities and Qualifications
- Serve as a primary point of contact for members, providing timely, accurate, and professional assistance.
- Manage a high volume of inbound calls while maintaining excellent customer service.
- Answer questions regarding eligibility, benefits, coverage, referrals, provider networks, and plan operations.
- Research member information across multiple systems to resolve questions, concerns, and complaints.
- Accurately document all member interactions and track inquiries through final resolution.
- Coordinate with members, healthcare providers, and internal departments to address service needs.
- Protect confidential information and follow all applicable privacy, compliance, and regulatory requirements.
- Demonstrate strong communication, interpersonal, problem-solving, data-entry, and organizational skills.
- Ability to multitask, work independently, and remain professional in a fast-paced environment.
- Associate' s degree or 6- 12 months of related education, training, or work experience required.
- Previous experience in a call center, medical office, health plan, or healthcare environment is preferred.
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