Member Services Representative

This role is responsible for delivering high-quality member/customer support by addressing inquiries, resolving issues, and ensuring a positive service experience across areas such as enrollment, benefits, billing, and claims. The position requires strong communication, problem-solving, and organizational skills in a fast-paced, service-driven environment.

Key Responsibilities

• Provide personalized support via phone, electronic channels, or in person, resolving inquiries related to benefits, eligibility, claims, billing, and authorizations
• Accurately document all interactions and ensure proper follow-up and resolution
• Meet or exceed performance metrics for productivity, quality, and customer satisfaction
• Apply empathy and professionalism in all interactions, maintaining a customer-first approach
• Maintain knowledge of industry practices, systems, and regulatory requirements
• Collaborate with internal teams to address and resolve member needs efficiently
• Manage time effectively to handle a high volume of requests in a fast-paced environment
• Ensure confidentiality of sensitive information and compliance with company policies

• High school diploma or equivalent required; some college preferred
• 2+ years of customer service experience (call center, administrative, or similar environment preferred)
• Strong written and verbal communication skills
• Proficiency in computer systems, including Windows-based tools and standard office software
• Ability to navigate multiple systems, manage data, and maintain accuracy
• Strong problem-solving skills with the ability to work independently
• Preferred experience in health insurance, Medicare, or regulated industries

• Ability to work in a fast-paced environment while maintaining professionalism and efficiency
• Strong attention to detail and organizational skills
• Comfortable working in a remote or hybrid setting
• Ability to maintain a calm, professional, and service-oriented demeanor in all interactions