Member Service Representative

Job Description

Job Description

Member Services Representative (Remote/Hybrid)

Work Location: Training onsite at KCA Pearland Administrative Office; transitions to remote/hybrid following successful completion of training and performance requirements.
Schedule: Flexible availability between 8:00 AM–8:00 PM, 7 days a week , including potential weekend coverage during Annual Enrollment Period (AEP).
Contract: 08/24/2026 to 03/31/2027
Pay Rate: $12.80/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance and 401(k)

Position Overview

We are seeking an experienced and compassionate Member Services Representative to provide phone-based customer service support to health plan members. This position will assist members with questions regarding benefits, eligibility, claims, providers, pharmacy services, appeals, grievances, and general health plan information.

Key Responsibilities

• Handle a high volume of inbound calls from health plan members.
• Assist members with questions regarding benefits, eligibility, claims, providers, pharmacy services, appeals, and grievances.
• Research member concerns and provide accurate, timely resolutions.
• Use active listening, empathy, problem-solving, and de-escalation techniques when handling difficult or sensitive situations.
• Navigate multiple computer systems simultaneously to research information and assist members.
• Accurately document member interactions, inquiries, and resolutions.
• Maintain strict confidentiality and comply with HIPAA and PHI privacy requirements.
• Support increased call volume during Annual Enrollment Period (AEP).
• Provide a high level of customer service while meeting established quality and productivity standards.
• Work independently and manage multiple priorities effectively in a remote environment after training.

Required Qualifications

• Minimum 5 years of healthcare experience required.
• Experience with Medicare Advantage, health insurance, member services, claims, benefits, or healthcare customer service strongly preferred.
• Excellent verbal and written communication skills.
• Strong problem-solving and critical-thinking abilities.
• Demonstrated ability to de-escalate challenging member interactions.
• Strong multitasking and organizational skills.
• Ability to navigate multiple computer systems and applications.
• Ability to protect confidential member and health information.
• Ability to work independently with minimal supervision after training.

Remote Work Requirements

• Reliable high-speed wired internet through cable, fiber, or DSL.
• Mobile hotspots and cellular 5G internet are not permitted.
• Basic technical skills, including the ability to troubleshoot connectivity issues and set up required equipment.
• Ability to understand basic computer installation and equipment requirements.
• Ability to work with dual monitors .
• Dedicated and professional remote work environment.