Member Services Representative II

Member Service Representative II

Western Health Advantage is seeking a compassionate, customer-focused Member Service Representative II to serve as a primary point of contact for members, providers, brokers, and plan partners. In this role, you will assist with benefit, eligibility, billing, and claims-related inquiries while delivering exceptional service and resolving complex member concerns.

We are looking for someone who demonstrates empathy, patience, and a genuine desire to support members as they navigate their healthcare needs. Strong listening skills, attention to detail, and the ability to communicate clearly and effectively are essential for success in this role. Candidates should be comfortable problem-solving, investigating issues thoroughly, and collaborating with internal and external partners to ensure timely and accurate resolutions.

If you thrive in a fast-paced environment, enjoy building trust with customers, and take pride in making a meaningful difference in people's lives, we encourage you to apply.

Key Responsibilities

• Respond to member inquiries via phone, email, chat, and fax regarding commercial, exchange, and individual plans.
• Research and resolve member concerns, including complex cases and urgent access-to-care issues.
• Assist members, providers, brokers, and plan partners with benefits, claims, billing, and plan information.
• Accurately document interactions, appeals, and grievances according to established procedures.
• Collaborate with internal departments and external partners to ensure timely issue resolution.
• Support and mentor team members by providing guidance on benefits, policies, and systems.
• Assist with training and call shadowing for new Member Service Representatives.
• Promote member self-service resources and online tools.
• Meet departmental performance, quality, and attendance standards.

Qualifications

• High School Diploma or equivalent required.
• Minimum two (2) years of call center or customer service experience.
• Healthcare or HMO experience preferred.
• Strong communication, problem-solving, and customer service skills.
• Proficiency with basic computer applications, including email, word processing, and spreadsheets.