Member Services Representative

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

📋 Description

• Act as the primary point of contact for members seeking help with their health plan benefits, account status, and service-related questions.

• Address inbound calls and digital inquiries from members concerning benefits, claims, payments, and services.

• Resolve 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.

• Provide education to members regarding plan options and advocate for suitable services when applicable.

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

• Achieve or surpass performance metrics, including call handling time, resolution rate, 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 enrollment, pharmacy tech, healthcare call center dealing with insurances, or a related field.

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

• Comfortable managing multiple systems simultaneously.

• Strong problem-solving and critical-thinking abilities.

• Capacity to thrive in a fast-paced, high-volume environment.

• Service-oriented attitude with a dedication to assisting others.

• Patient, empathetic, and composed under pressure.

• Positive, professional, and collaborative demeanor.

• Receptive to feedback and committed to ongoing improvement.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital insurance.

• 401(k) Retirement Plan – Offers Pre-tax and Roth post-tax contributions.

• Life Insurance (Voluntary Life & AD&D for the employee and dependents).

• Short and long-term disability coverage.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

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