Member Services Representative

The Member Services Representative is responsible for delivering exceptional customer service to health plan members by addressing inquiries, resolving concerns, and providing accurate information regarding benefits, eligibility, enrollment, claims, billing, and authorizations. This role requires strong communication skills, attention to detail, problem-solving abilities, and a customer-focused approach in a fast-paced call center environment.

Key Responsibilities

• Provide personalized support to members via telephone, email, and other communication channels.
• Respond to inquiries regarding enrollment, benefits, eligibility, claims, billing, authorizations, and health plan services.
• Document all member interactions accurately within the tracking and customer service systems.
• Investigate and resolve member complaints and concerns in a timely and professional manner.
• Meet established productivity, quality, and customer satisfaction standards.
• Demonstrate empathy, professionalism, and a service-oriented attitude in all member interactions.
• Maintain confidentiality of member health information in compliance with HIPAA and company policies.
• Utilize internal systems and resources to research and resolve issues effectively.
• Collaborate with internal departments and management to address complex member concerns.
• Remain current on health insurance regulations, policies, procedures, and system updates.

Minimum Qualifications

Education

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

Experience

• Minimum of 2 years of customer service, call center, or administrative support experience.
• Medicare, Medicaid, health insurance, managed care, or healthcare customer service experience strongly preferred.

Required Skills

• Strong verbal and written communication skills.
• Excellent customer service and conflict-resolution abilities.
• Proficiency with Windows-based computer systems and data entry.
• Ability to navigate multiple systems while handling member calls.
• Strong organizational and time-management skills.
• Ability to work independently and exercise sound judgment.
• Knowledge of call center operations and documentation practices.
• Experience with health insurance systems such as Amisys and Macess is preferred.
• Comfortable working in a remote environment, including use of VPN, Wi-Fi, headset, and related technology.

At Encode, we believe that our employees are our greatest asset, and we are committed to fostering a supportive and inclusive work environment. We offer a comprehensive benefits package that includes health insurance, retirement plans, and generous paid time off. Our flexible work arrangements and emphasis on work-life balance ensure that our employees can achieve their professional goals while maintaining a healthy personal life. Additionally, we provide opportunities for continuous learning and career advancement, including professional development programs and access to cutting-edge technologies.

As a cleared facility, we have a particular need for individuals with active Secret or Top Secret clearances. Your expertise and security clearance would be invaluable in supporting our mission-critical projects and ensuring the highest standards of security and compliance.

We would love to discuss how your experience and skills align with our needs and explore potential opportunities with Encode. If you are interested in learning more, please reply to this email with your updated resume and a convenient time for a brief conversation.

Thank you for considering this opportunity. We look forward to the possibility of working together and contributing to your professional journey.