Healthcare Customer Service Representative – Claims & Member Services

Position: Member Service Representative I

Location: 100% Remote (DMV + 11 regions)

Job Description:

We are seeking customer-focused professionals with experience in healthcare claims, health insurance, and inbound call center operations. The ideal candidate will handle member inquiries, assist with claims processing, support enrollment and billing transactions, and provide accurate information regarding benefits, policies, and contractual provisions.

Key Responsibilities:

• Respond to inbound member inquiries regarding benefits, claims, enrollment, billing, and policy information.
• Research and resolve customer service issues, escalating complex cases when necessary.
• Review claims, verify processing requirements, and assist with resolving payment discrepancies.
• Support enrollment transactions and billing activities in accordance with established guidelines.
• Educate members, clients, providers, and group administrators on benefits, contractual provisions, and procedures.
• Maintain accurate documentation of customer interactions and follow established service standards.
• Navigate multiple systems simultaneously while delivering excellent customer service.
• Collaborate with internal teams and clinical professionals to support appropriate managed care interventions.

Required Qualifications:

• High school diploma or GED.
• Minimum of 1 year of customer service, claims processing, or inbound call center experience.
• Preferably 2–5 years of inbound call center experience.
• Experience in healthcare, health insurance, medical information, or claims-related operations.
• Strong verbal and written communication skills.
• Excellent problem-solving, organizational, and time-management abilities.
• Ability to work independently in a remote, fast-paced, quality-driven environment.
• Proficiency in Microsoft Office, email, internet research, and navigating multiple software applications.