Healthcare Member Services Representative

A Healthcare Customer Service Representative provides exceptional support to patients, members, and healthcare providers by handling inquiries related to health insurance, benefits, claims, billing, appointments, and medical services. This role ensures accurate information is provided while maintaining confidentiality and compliance with healthcare regulations.

Key Responsibilities

• Respond to customer inquiries via phone, email, or chat in a professional and timely manner.
• Assist patients and members with health insurance benefits, eligibility, claims, and billing concerns.
• Schedule, confirm, or reschedule appointments as needed.
• Verify patient information and update records accurately in company systems.
• Resolve customer issues by researching accounts and coordinating with appropriate departments.
• Educate customers on healthcare plans, policies, and available services.
• Document all customer interactions accurately and maintain detailed records.
• Ensure compliance with HIPAA and company privacy policies.
• Meet quality, productivity, and customer satisfaction goals.
• Escalate complex cases to supervisors or specialized departments when appropriate.

Qualifications

• High school diploma or equivalent; college education is an advantage.
• Previous experience in healthcare customer service, medical billing, insurance, or a call center is preferred.
• Strong verbal and written communication skills.
• Excellent problem-solving and conflict-resolution abilities.
• Basic computer proficiency and experience with CRM or healthcare systems.
• Ability to multitask in a fast-paced environment while maintaining accuracy.
• Knowledge of medical terminology or health insurance processes is an advantage.
• Minimum of 6 months of US Healthcare Operations / Medical Billing or Revenue Cycle Management experience.