Member Services Rep - Health Plan Admin

Summary:

Serves as a frontline ambassador for the health plan, delivering high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business. Provides support beyond basic call handling which includes navigating the foundational pillars of our healthcare offerings, including the Health Exchange, US Family Health Plan, and NCHD, with a strong emphasis on first-call resolution.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Resolve member, provider, or broker inquiries across Health Exchange, US Family Health Plan, and NCHD. Quote basic eligibility and benefits for Medicare Advantage inquiries, with emphasis on provider-facing interactions.
• Resolve routine inquiries during initial contact using standardized scripting, system navigation, and clear documentation.
• Document call interactions in the CRM with clarity, accuracy, and resolution details that support audit readiness and downstream coordination.
• Explain core benefits and eligibility using handbook-aligned language; assist members in understanding coverage and accessing services.
• Guide members through navigation of the CHRISTUS website and their individual member portal.
• Professionally redirect providers to approved electronic channels (portal, 270/271, 276/277) for eligibility and claims status, in alignment with policy.
• Maintain performance expectations, including total calls handled, average call handle time, average hold time compliance, and schedule adherence.
• Advocate on the part of the beneficiary to resolve any issue with care.
• Support and deliver assigned projects under leadership direction, contributing to team goals and operational excellence.

Job Requirements:

Education/Skills

• High school diploma or GED is required
• Strong verbal and written communication skills, with the ability to convey complex information clearly and professionally
• Ability to multitask and manage time effectively in a fast-paced, metric-driven environment
• Demonstrated attention to detail and accuracy in documentation and data entry
• Basic proficiency in Microsoft Office Suite (Word, Excel, Outlook) and ability to learn proprietary systems quickly
• Ability to work collaboratively in a team setting while independently managing assigned tasks
• Professional demeanor and customer-first mindset, with a focus on empathy, patience, and problem-solving
• Ability to participate in scheduled overtime during high-volume periods
• Ability to work remotely on scheduled work-from-home days and during unscheduled building closures (e.g., inclement weather, power outages, or emergency events), with reliable internet access and adherence to all remote work protocols.
• Demonstrate ability to interpret claim statuses in CRM, explain routine denial codes in plain language, and guide members to their EOBs for further detail and resolution.
• Ability to follow crisis call protocols with proficiency and care.
• Participate in progressive training modules and skill assessments that support career advancement within Member Services.
• Demonstrate understanding of member’s rights and responsibilities, FWA, and remain HIPAA compliant during member/provider interactions.
• Provide customer service excellence through engagement, effective listening skills, patience, and desire to resolve the question/issue.

Experience

• Experience in customer service, ideally in healthcare, insurance, or call center environment

Licenses, Registrations, or Certifications

• None required

In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time