Member Service Representative

Description:

Job Title: Member Services Representative

Job Description:
Provides phone-based customer service support to health plan members by assisting with benefits, eligibility, claims, providers, pharmacy services, appeals, grievances, and general plan questions. Responsible for researching and resolving concerns, using de-escalation skills, documenting interactions, navigating multiple systems, and delivering excellent member service.

Key Responsibilities:

• Handle high-volume inbound member calls.
• Assist with benefit, claims, provider, pharmacy, appeal, and grievance inquiries.
• Resolve member concerns using empathy, problem-solving, and de-escalation skills.
• Document interactions accurately while maintaining HIPAA/PHI compliance.
• Navigate multiple systems and support AEP call volume.

Required Qualifications:

• Minimum 5 years of healthcare experience required, preferably in Medicare advantage plans, Health insurance, member services, claims, benefits, or customer service.
• Strong communication, multitasking, problem-solving, and de-escalation skills.
• Ability to protect confidential member information and navigate multiple systems.
• Ability to work independently in a remote environment after training.

Remote Requirements:

• Reliable high-speed wired internet (cable, fiber, or DSL); mobile hotspots and cellular 5G internet are not permitted.
• Basic technical skills to troubleshoot connectivity issues, set up equipment, and understand computer installation requirements.
• Ability to use dual monitors.

Work Location:
Training onsite at KCA Pearland Administrative Office; position transitions to remote/hybrid after successful training and performance completion.

Schedule:
Flexible availability between 8:00 AM–8:00 PM, 7 days a week, including possible weekend coverage during AEP.

#ZR

Allmed is a National Staffing and Recruiting company offering short and long term staffing solutions.
We have been serving large Fortune 100 companies and providing career opportunities to job seekers for over 25 years. We specialize within the medical and healthcare industries offering temporary and permanent placement options. Our team takes the time to recognize, assess and listen to the goals of both our clients and employees. Our team is dedicated to providing the highest quality services and best qualified medical
professionals throughout the United States. We stand by our promise and guarantee success and satisfaction between our clients and employees.