Member Services Representative (Healthcare BPO)

We are hiring a dedicated Member Services Representative to join our Healthcare Business Process Outsourcing (BPO) team. This position is the primary point of contact for health plan members, requiring excellent communication skills to provide support and information regarding their benefits, eligibility, and claims.

Member Support & Inquiry Resolution

• Answer high-volume inbound calls from plan members, providers, and sometimes employers regarding health insurance benefits, plan coverage, and eligibility.
• Educate members on how to use their health plan, including co-pays, deductibles, out-of-pocket maximums, and network providers.
• Resolve complex inquiries concerning claim status, billing disputes, and payment processing.
• Process and document necessary adjustments or requests accurately and efficiently according to HIPAA and company guidelines.

Documentation & Compliance

• Maintain meticulous records of all member interactions, resolutions, and follow-up actions in the CRM system.
• Adhere strictly to HIPAA (Health Insurance Portability and Accountability Act) privacy and security rules and all other regulatory compliance standards.
• Collaborate with internal departments (e.g., Claims, Billing) to ensure timely and accurate resolution.