Member Services Specialist

Job Summary

Serving as a frontline ambassador for the health plan, the full-time Member Services Specialist will deliver high-quality, resolution-focused support to members, providers, and brokers while mastering core systems and navigating healthcare offerings in a structured environment.

Key responsibilities

• Resolve member, provider, or broker inquiries across various health plans, ensuring first-call resolution and accurate documentation
• Develop proficiency in core systems for eligibility verification and claims review to independently manage inquiries
• Provide exceptional customer service by guiding members through benefit explanations and website navigation

Required qualifications

• High school diploma or equivalent is required
• Basic proficiency in Microsoft Office Suite (Word, Excel, Outlook) and ability to learn proprietary systems quickly
• 0-2 years of customer service experience preferred, ideally in healthcare, insurance, or call center environments