Member Services Representative

Member Services Representative

We are seeking a Member Services Representative to serve as a key point of contact for Capital Health Plan members and the community. This role is responsible for responding to high-volume inquiries, providing accurate information regarding health plan benefits and services, and assisting with issue resolution to ensure a positive member experience.

The Member Services Representative answers inbound calls, documents interactions in system databases, researches and resolves member concerns, and collaborates with internal teams to address inquiries related to eligibility, benefits, referrals, and services. This role plays a critical part in ensuring inquiries and complaints are handled accurately, professionally, and within established timeframes.

We're looking for someone who has:

• Associate's degree from an accredited two-year college or technical school, or equivalent education and experience
• Minimum of one year of related experience (call center, medical office, or customer service environment preferred)
• Ability to communicate clearly and professionally with members, staff, and the public by phone and in written communication
• Strong problem-solving skills with the ability to research and resolve member inquiries
• Ability to manage a high volume of calls while maintaining accuracy and professionalism
• Strong data entry and documentation skills, with the ability to track and follow up on member interactions
• Ability to work within established policies, procedures, and service timelines

Highly preferred candidates also have:

• Experience working in a call center or healthcare customer service environment
• Knowledge of health plan benefits, eligibility, or referral processes
• Experience handling and resolving member complaints or escalations
• Familiarity with customer service systems or call tracking software
• Strong interpersonal skills and the ability to de-escalate concerns in a professional manner

About Capital Health Plan (CHP):

CHP is a locally based, not-for-profit health maintenance organization serving the Tallahassee region for more than four decades. Founded by community leaders with a mission to deliver high-quality and patient-centered health care, CHP has grown into a nationally recognized healthcare organization while remaining deeply rooted in the communities it serves.

CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.