Member Services Representative

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Answer incoming calls and digital inquiries from members about their benefits, claims, payments, and services.

• Address member issues with professionalism and empathy, aiming for first-contact resolution whenever feasible.

• Accurately document all interactions in the system in accordance with compliance and procedural standards.

• Inform members about plan options and advocate for relevant services when appropriate.

• Work collaboratively with internal departments and external partners (such as medical groups and facilities) to resolve intricate issues.

• Achieve or surpass performance metrics, including call handling time, resolution rates, and customer satisfaction.

• Engage in ongoing training and coaching sessions to keep knowledge of products and procedures current.

⛳️ Requirements

• 1-3 years of experience in healthcare customer service.

• Familiarity with healthcare insurance.

• Must reside in the Eastern Standard Time zone.

• Competent in using Windows-based systems (Outlook, Word, Excel, internet browsers).

• Comfortable navigating multiple systems at the same time.

• Strong problem-solving and critical-thinking abilities.

• Capable of working in a fast-paced, high-volume environment.

• Service-oriented attitude with a genuine desire to assist others.

• Patient, empathetic, and composed under pressure.

• Positive, professional, and collaborative demeanor.

• Receptive to feedback and dedicated to ongoing improvement.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital insurance.

• 401(k) Retirement Plan – Options for pre-tax and Roth post-tax contributions available.

• Life Insurance (Voluntary Life & AD&D available for employees and dependents).

• Short and long-term disability coverage.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

• Paid Time Off/Leave (PTO, Vacation, or Sick Leave).