Member Services Specialist
Job Responsibilities:
- Meets expectations of the applicable Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Respond to inbound calls, emails, and member chat messages regarding healthcare-related questions and concerns.
- Adhere to established service level agreements (SLAs) and quality standards to consistently deliver excellent customer service about insurance benefits, claims, coverage, and other related inquiries. Assist members in navigating the healthcare system and understanding their rights and responsibilities.
- Investigate and resolve member complaints, issues, and escalations promptly and satisfactorily. Document all customer interactions and issue resolutions accurately and comprehensively in the CRM system.
- Collaborate with internal departments to facilitate issue resolution and ensure a seamless customer experience.
- Explain insurance plans, policies, and procedures to members, ensuring they understand their benefits and coverage clearly.
- Provide guidance on accessing healthcare services, locating in-network providers, and understanding pre-authorization requirements.
- Continuously enhance product knowledge and stay updated on industry trends and changes.
- Identify process improvement opportunities and provide recommendations to enhance the overall member experience.
- Proactively contribute to the development and implementation of customer service best practices.
- Collaborate with team members and management to improve operational efficiency and streamline workflows and customer satisfaction.
- Support USFHP, HIX, and NCHD LOB as needed. Participate in training sessions and professional development activities to enhance knowledge and skills.
Skills:
- Customer Service,
- member service,
- insurance,
- claims,
- healthcare
Education/Experience:
- A High School diploma or equivalent is required. 0 -2 years of customer service experience is preferred. Work Type: Full Time
Recommended Jobs
Senior Business Data Analyst Public Sector (Eligibility/Data Systems)
Job Title: Systems Analyst 3 Market Title: Senior Business Data Analyst – Public Sector (Eligibility/Data Systems) Work Type: Hybrid – 3 days onsite (Mon, Tue & Thu) Location: 46…
Senior Actuarial Analyst (Waco)
Come work for a stable organization with a solid plan for growth. Texas based client is seeking a talented Senior ActuarialAnalyst. This individual will be responsible for developing rate level indica…
Sr. Software Engineer
What We Do Shape the future of cybersecurity at Forescout. Each day cyberattacks threaten to disrupt hospitals, power grids, financial systems, and the infrastructure we all depend on. At Fo…
Restaurant General Manager
Position: General Manager Location: Houston, TX | Relocation Assistance Available Compensation: $90,000 - $110,000 + 10% bonus We are conducting a search for an experienced General Manag…
Patient Support Agent (McAllen)
Description: Thurmond Eye Associates has been serving Hidalgo, Starr, and Cameron Counties for over 60 years, and is proud to be the leading ophthalmic group in the community. We offer a full spectru…
Financial Accountant II (Non CPA)
Financial Accountant II (Non CPA) Location Austin, TX (Johnston Terrace area) : Job Summary:: The Financial Accountant II is responsible for the financial activities of assigned programs, the prepara…
Administrative Assistant SUD
Administrative Assistant SUD Location El Paso, TX : Job Code: AA - 106 Revision Date: December 13, 2025 Starting Salary: $14.57 hourly; $30,301 annually FLSA: Non-Exempt Overview We are…
Assistant Store Manager FT
About Our Company General Position Summary Generate Sales Produce sales gains, by providing customer service. To meet or exceed Company Objectives in all individual statistics. Learn t…
Chief of Schools
Region: 19 School District/Employer: District Category/Employer: Central Office, Position: , Assig…
Sales Supervisor
Kate Spade is seeking a Sales Supervisor for its San Marcos, TX location. This role involves overseeing daily sales operations, leading the sales team, and ensuring exceptional customer service. The i…