Member Services Representative (Call Center) {170299}

Job Description

Job Description

Job Title: Member Services Representative (Call Center)
Location: Alameda, CA 94502 (Onsite)
Schedule: Monday–Friday, 8:00 AM–5:00 PM
Pay: $28.61

Looking for a steady, professional call center role where you can help members solve real problems and navigate health plan benefits? This  Member Services Representative position is a high-volume, service-first role supporting routine and complex member inquiries across phone, email, chat, fax, and written correspondence. If you have strong customer service instincts, can stay calm under pressure, and document accurately, this  Member Services Representative opportunity offers consistent hours and meaningful work in managed care operations.

Responsibilities

• Handle a high volume of inbound/outbound calls and multichannel requests (phone, email, chat, fax, letters)
• Resolve questions related to benefits, eligibility, claims, authorizations, pharmacy, and plan services
• De-escalate dissatisfied callers and provide clear solutions and next steps
• Research issues across multiple systems/databases and coordinate with internal teams for resolution
• Accurately document all interactions and outcomes in a CRM/electronic database
• Track and follow up on open items to ensure timely closure and service excellence
• Educate members on managed care basics, self-service tools, and how to maximize plan benefits
• Coordinate with departments such as Claims, Enrollment, IT, Network Management, Pharmacy, and Authorizations
• Meet performance metrics for call quality, efficiency, member satisfaction, punctuality, and attendance

Qualifications

• High school diploma/GED required (additional education or equivalent experience preferred)
• 1+ year of direct customer service experience (call center experience preferred)
• Comfortable with high-volume phones, headset use, and multi-monitor computer work
• Strong data entry skills with consistent accuracy in documentation
• Professional communication, active listening, and problem-solving skills
• Managed care experience is a plus
• Bilingual skills may be a plus (role-dependent)