Member Services Representative

Job#: 3053178

Job Description:

We are seeking a customer-focused and empathetic Member Services Representative II to serve as a trusted resource for members seeking assistance with their healthcare benefits and insurance-related inquiries. This individual will play a critical role in delivering a high-quality member experience by providing accurate information, resolving issues efficiently, and ensuring compliance with healthcare regulations and company standards.

The ideal candidate will have previous experience in a customer service or call center environment, possess strong communication skills, and demonstrate the ability to navigate complex healthcare and insurance-related questions. This role requires a balance of professionalism, problem-solving abilities, empathy, and attention to detail while supporting members through a variety of benefit and coverage inquiries.

Key Responsibilities

Member Support & Customer Service

• Serve as the primary point of contact for members via phone, email, and other communication channels.
• Assist members with questions related to health insurance benefits, eligibility, enrollment, claims processing, billing inquiries, authorizations, and coverage concerns.
• Provide personalized support while educating members on available benefits, programs, and resources.
• Resolve member issues efficiently while ensuring a positive customer experience during each interaction.
• Escalate complex issues to appropriate internal departments and coordinate resolution efforts on behalf of members.

Case Management & Documentation

• Accurately document all member interactions, concerns, complaints, and resolutions within internal tracking systems.
• Maintain detailed records that comply with organizational standards, regulatory requirements, and quality assurance guidelines.
• Track open issues and monitor follow-up activities to ensure timely resolution.

Quality & Performance

• Consistently meet or exceed established service-level goals, productivity metrics, quality standards, and member satisfaction expectations.
• Demonstrate professionalism, empathy, and active listening during all member interactions.
• Utilize proper call-handling techniques while effectively managing multiple priorities in a fast-paced environment.

Compliance & Industry Knowledge

• Maintain a strong understanding of health insurance products, Medicare guidelines, eligibility rules, claims processes, and industry regulations.
• Stay current on changes in healthcare regulations, organizational policies, and operational procedures.
• Handle protected health information (PHI) and confidential business information in accordance with HIPAA and company privacy standards.
• Ensure compliance with all departmental, regulatory, and organizational requirements.

Collaboration & Problem Resolution

• Partner with internal departments including Enrollment, Claims, Billing, Care Management, and Provider Relations to resolve member concerns.
• Use analytical thinking and independent judgment to determine appropriate solutions based on policy and procedure.
• Identify trends in member concerns and provide feedback that may improve processes or member satisfaction.

Required Qualifications

Education

• High School Diploma or GED required.
• Associates degree or some college coursework preferred.

Experience

• Minimum of 2 years of customer service, member services, call center, healthcare administration, insurance operations, or related experience.
• Prior experience supporting Medicare members, health insurance plans, or healthcare-related services is strongly preferred.
• Experience working in a metrics-driven or performance-focused environment preferred.

Desired Skills & Competencies

Customer Service Excellence

• Exceptional communication and interpersonal skills.
• Demonstrated ability to build rapport and establish trust with members.
• Strong conflict resolution and de-escalation skills.
• Ability to display empathy while maintaining professionalism and efficiency.

Technical Skills

• Proficiency with Microsoft Windows applications and computer-based systems.
• Ability to navigate multiple software applications simultaneously while engaging with members.
• Experience with customer relationship management (CRM) platforms, case management systems, or healthcare administration software is preferred.
• Comfortable using VPN access, remote work technologies, headsets, and virtual communication tools.

Organizational Skills

• Strong attention to detail and accuracy in documentation.
• Excellent time management and prioritization abilities.
• Ability to manage a high volume of requests while maintaining service quality.

Critical Thinking

• Demonstrates sound judgment and decision-making capabilities.
• Ability to interpret policies, procedures, and benefit guidelines to resolve member concerns.
• Strong analytical and problem-solving skills.

Work Environment

• Primarily remote and telephone-based customer service environment.
• Extensive interaction with members throughout the workday.
• Fast-paced setting with performance expectations related to quality, productivity, and member satisfaction.
• Flexible schedule may be required to support business needs.

Physical Requirements

• Ability to sit for extended periods while working on a computer and handling member calls.
• Manual dexterity required for keyboarding and system navigation.
• Ability to occasionally bend, stoop, stretch, and lift up to 20 pounds.
• Must be able to effectively use a computer, headset, telephone, and standard office equipment.

Ideal Candidate Profile

The successful candidate will be a compassionate and detail-oriented customer service professional who enjoys helping others navigate healthcare-related questions and challenges. They will possess strong communication skills, thrive in a fast-paced environment, demonstrate accountability for results, and consistently deliver an exceptional member experience while maintaining compliance and confidentiality standards.

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178.

Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.

Everforth Apex uses a virtual recruiter as part of the application process. Click here for more details. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Everforth Apex and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at https://www.apexsystems.com/privacy-policy

Everforth Apex Benefits Overview: Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Everforth Apex team member can provide.

Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

If you require an accommodation under the Americans with Disabilities Act to participate in an interview with a virtual recruiter or to use our website for a search or application, please contact our Benefits Department at [email protected] or 804-523-8228. Please note that this contact information is strictly to be used for medical ADA accommodations and that no other inquiries will be answered.

UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Everforth Apex Systems.

Employee Type:

Contract

Location:

Akron, OH, US

Job Type:

Date Posted:

September 23, 2026

Pay Range:

$16 - $17 per hour

Similar Jobs

• Member Services Representative
• Medicare Member Engagement Representative
• Service Center Representative
• Customer Service Representative
• Service Center Representative