Member Services Agent

Summary:

• Duration: 22 week contract
• Work Mode: Remote (Must have prior experience working remotely)
• Shift: M-F 8-5 PST

Responsibilities:

• Answer and manage inbound member and patient calls with professionalism, empathy, and excellent customer service.
• Educate members regarding healthcare benefits, coverage, eligibility, referrals, authorizations, provider networks, claims, and member rights and responsibilities.
• Research, troubleshoot, and resolve member issues, escalating complex concerns when appropriate.
• Facilitate warm transfers and coordinate with internal departments to ensure seamless service.
• Conduct follow-up communication and callbacks to ensure issue resolution and member satisfaction.
• Serve as a liaison between members, patients, providers, and contracted health plans as needed.
• Accurately document all member interactions, requests, updates, and resolutions in the managed care information system.
• Maintain accurate records and process department-assigned requests in accordance with established protocols.
• Utilize departmental resources, systems, and tools to support service delivery and productivity goals.
• Adhere to call handling standards, customer service protocols, and approved communication scripts.
• Maintain compliance with HIPAA, confidentiality requirements, and all applicable healthcare regulations.
• Support departmental quality improvement initiatives and recommend process improvements when appropriate.
• Monitor and contribute to achieving customer service, quality, and productivity metrics.

Requirements:

• High School Diploma, GED, or equivalent.
• Minimum of 3 years of customer service, member services, or related experience in a healthcare environment.
• Strong verbal and written communication skills, including professional email etiquette, proper grammar, accurate documentation, clear formatting, and attention to detail.
• Ability to handle sensitive situations with empathy, professionalism, and confidentiality.
• Strong problem-solving, organizational, and multitasking skills.
• Proficiency with computer systems, Microsoft Office applications, and data entry.
• Ability to work effectively in a fast-paced environment with high call volumes, interruptions, and changing priorities.
• Ability to collaborate as part of a team and provide cross-coverage as needed.
• Ability to work standard business hours (8:00 AM – 5:00 PM PST) and occasional overtime when required.

Preferred Skills:

• Experience with EPIC Tapestry, CRM systems, or similar healthcare technology platforms.
• Experience working in managed care, health plans, or healthcare customer service environments.