Member Services Rep. II

Job Description

We are looking for a dedicated Member Services Representative II to join our team in Pearland, Texas. This role is a long-term contract position where you will deliver exceptional service to health plan members by addressing inquiries, resolving concerns, and supporting retention initiatives. Ideal candidates will have a strong understanding of Medicare policies and health plan operations, as well as the ability to handle both inbound and outbound communications effectively.

Responsibilities:

• Provide high-quality concierge-level service to health plan members through phone and chat communications.

• Conduct outreach calls to educate members on health plan policies, promote retention efforts, and gather required survey responses.

• Address and resolve inquiries related to claims, premium billing, benefit coverage, referrals, and prescription drug issues.

• Interpret and apply Medicare policies, including enrollment processes, low-income subsidies, and beneficiary protections.

• Assist members with appointment scheduling and follow up on disenrollment reasons to improve retention.

• Utilize software tools, including Epic, to manage administrative tasks and respond to member needs efficiently.

• Support chat-based member interactions while maintaining excellent service standards.

• Ensure compliance with quality and productivity metrics in all member and provider interactions.

• Provide language interpretation services, including Spanish, to meet the needs of diverse members.

• Collaborate with internal teams to address operational issues and improve overall service delivery.• Proven experience in customer service, preferably within a healthcare or health plan setting.

• Solid understanding of Medicare policies, coverage rules, and beneficiary protections.

• Proficiency in using software applications such as Epic for managing member inquiries and administrative tasks.

• Strong organizational and multitasking skills to handle a variety of member and provider concerns.

• Excellent verbal and written communication skills, including the ability to provide language interpretation in Spanish.

• Familiarity with medical billing, claims administration, and benefit functions.

• Ability to meet productivity and quality standards in a fast-paced environment.

• Exceptional interpersonal skills to build trust and rapport with members and providers.

Fully remote