Member Services Representative

SummaCare is seeking experienced and customer-focused Member Services Representatives to provide exceptional support to health plan members. This role serves as the primary point of contact for members regarding enrollment, eligibility, benefits, claims, billing, authorizations, and other health insurance-related inquiries.

The ideal candidate will possess strong customer service skills, prior call center or administrative support experience, and a solid understanding of Medicare and/or health insurance programs. Representatives must demonstrate professionalism, empathy, problem-solving abilities, and a commitment to delivering high-quality service.

Key Responsibilities

• Provide personalized support to members via telephone, electronic communication, or in-person interactions.
• Respond to inquiries regarding enrollment, eligibility, benefits, billing, claims, authorizations, and other health plan services.
• Accurately document member inquiries, complaints, and resolutions in the appropriate tracking systems.
• Meet or exceed established departmental productivity and quality standards.
• Utilize empathy, education, and empowerment techniques during all member interactions.
• Research and resolve member concerns while maintaining a high level of customer satisfaction.
• Apply independent judgment and problem-solving skills to interpret policies and procedures.
• Maintain knowledge of health insurance regulations, Medicare guidelines, and internal systems.
• Ensure compliance with company policies, HIPAA requirements, and confidentiality standards.
• Collaborate with internal departments and management to resolve complex member issues.
• Deliver professional, timely, and respectful service to both internal and external customers.

Required Qualifications

Education

• High School Diploma or GED required.
• College coursework or degree preferred.

Experience

• Minimum of 2 years of experience in customer service, call center operations, or administrative support.
• Experience within Medicare, health insurance, managed care, or healthcare customer service environments is strongly preferred.

Skills & Competencies

• Strong customer service and communication skills.
• Ability to manage high-volume telephone interactions professionally.
• Proficiency with Microsoft Windows and computer-based systems.
• Excellent data entry, documentation, and keyboarding skills.
• Ability to work independently in a fast-paced environment.
• Strong organizational and time-management skills.
• Ability to learn and apply healthcare regulations, insurance policies, and company procedures.
• Experience with VPN connectivity, remote work technology, headsets, and office equipment preferred.
• Demonstrated ability to maintain confidentiality of protected health information (PHI).

Physical Requirements

• Ability to sit for extended periods.
• Frequent use of a computer, telephone, and headset.
• Occasional bending, stooping, and stretching.
• Ability to lift up to 20 pounds.

Important Assignment Information

• Candidates must reside within the Akron/Canton area to be considered.
• Initial orientation and training will be conducted onsite for approximately 4 weeks.
• Throughout the assignment, employees may be required to report to the office periodically.
• This is a seasonal assignment with an immediate hiring need.
• Candidates previously submitted and rejected for prior Member Services Representative openings should not be resubmitted.

At Encode, we believe that our employees are our greatest asset, and we are committed to fostering a supportive and inclusive work environment. We offer a comprehensive benefits package that includes health insurance, retirement plans, and generous paid time off. Our flexible work arrangements and emphasis on work-life balance ensure that our employees can achieve their professional goals while maintaining a healthy personal life. Additionally, we provide opportunities for continuous learning and career advancement, including professional development programs and access to cutting-edge technologies.

As a cleared facility, we have a particular need for individuals with active Secret or Top Secret clearances. Your expertise and security clearance would be invaluable in supporting our mission-critical projects and ensuring the highest standards of security and compliance.

We would love to discuss how your experience and skills align with our needs and explore potential opportunities with Encode. If you are interested in learning more, please reply to this email with your updated resume and a convenient time for a brief conversation.

Thank you for considering this opportunity. We look forward to the possibility of working together and contributing to your professional journey.