Member Services Representative \ 929

Paladin Consulting, Inc.

  • Irving, TX
  • 9 days ago
  • $19.33 Per Hour

Highlights

Summary: Serves as a frontline ambassador for the health plan, delivering high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business. Professionally redirect providers to approved electronic channels (portal, 270/271, 276/277) for eligibility and claims status, in alignment with policy.

Numbers & Facts

LocationIrving, TX
Salary$19.33 Per Hour

Description

Member Services Representative
-ONSITE
Summary:
  • Serves as a frontline ambassador for the health plan, delivering high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business. Provides support beyond basic call handling which includes navigating the foundational pillars of our healthcare offerings, including the Health Exchange, US Family Health Plan, and NCHD, with a strong emphasis on first-call resolution.
Responsibilities:
  • Meets expectations of the applicable Client Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Resolve member, provider, or broker inquiries across Health Exchange, US Family Health Plan, and NCHD. Quote basic eligibility and benefits for Medicare Advantage inquiries, with emphasis on provider-facing interactions.
  • Resolve routine inquiries during initial contact using standardized scripting, system navigation, and clear documentation. Document call interactions in the CRM with clarity, accuracy, and resolution details that support audit readiness and downstream coordination.
  • Explain core benefits and eligibility using handbook-aligned language; assist members in understanding coverage and accessing services. Guide members through navigation of the Client website and their individual member portal. Professionally redirect providers to approved electronic channels (portal, 270/271, 276/277) for eligibility and claims status, in alignment with policy.
  • Maintain performance expectations, including total calls handled, average call handle time, average hold time compliance, and schedule adherence. Advocate on the part of the beneficiary to resolve any issue with care. Support and deliver assigned project

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