Member Services Representative

Job Description

Position Overview:
As a Member Services Representative, you will be the first point of contact for members seeking assistance with their health plan benefits, account status, and service-related inquiries. This is a high-impact role requiring empathy, attention to detail, and a commitment to delivering exceptional service.

Key Responsibilities:
-Respond to inbound calls and digital inquiries from Medicare and Medicaid members regarding benefits, claims, payments, and services.
-Resolve member concerns with professionalism and empathy, ensuring first-contact resolution whenever possible.
-Document all interactions accurately in the system according to compliance and procedural standards.
-Collaborate with internal departments and external partners (e.g., medical groups, facilities) to resolve complex issues.
-Meet or exceed performance metrics including call handling time, resolution rate, and customer satisfaction.
-Participate in ongoing training and coaching sessions to maintain up-to-date knowledge of products and procedures.

Additional Skills & Qualifications

o Must have a High School Diploma or GED
o Must be flexible to work varied shifts ranging anywhere from 8 a.m. to 8 p.m., seven days a week.
o Possess excellent listening skills/ability to analyze for resolution and be solution-oriented.
o Must possess above-average verbal and written communication skills, proven soft skill abilities/proficiency, a strong attention to detail, and an interest in preventing errors.
o Demonstrate critical thinking and decision-making abilities.
o Must possess demonstrated competency in Windows (*Outlook, Word, Internet Explorer, Excel, and PowerPoint).
o Ability to deliver ‘delightful’ customer service experiences and build customer satisfaction and loyalty.
o Strike a positive and cooperative tone with both customers and coworkers.
o Possess a positive attitude, is upbeat, outgoing, and confident.
o Be self-reliant and dependable, ability to work independently and as a team.
o Be patient, stress-tolerant, and show empathy.
o Ability to thrive in a lively working environment and multi-task.
o Ability to accept constructive feedback.
o Possess ability and/or some experience in presentation capability to individuals, groups, and leadership audiences.
o Ability to mentor peer group in best practice standards
o Must be a team player, self-starter, and have demonstrated initiative.
o Must be able to build and/or retain excellent customer relationships.
o Must possess the ability to problem solve and resolve customer complaints.
o Must possess the ability to upsell our products and our company, possess a sales aptitude, be passionate about our products and our customers.
o Must possess basic reading, writing, and arithmetic skills (reading/math comprehension).
o Must be able to do some travel.
o Service-oriented, actively looking for ways to help people.
o Meet quality, productivity, and behavior expectations.