Member Services Representative

Member Services Representative-ONSITE (Local candidates only) Submit with proof of educations; High school diploma or GED is required 2yrs experience; Experience in customer service in healthcare, insurance, or call center environment Irving Corporate Health Plan Administration Office 5101 N. O'Connor Blvd, Irving TX 75039

Monday-Friday

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 One 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 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 sched