Job Description
Job Description
Job tiltes: Member Services Specialist
Location: Irving, TX US
Job Summary:
The Member Services Specialist plays a vital role in delivering exceptional customer service to our members by addressing their healthcare-related inquiries and concerns. This onsite position focuses on assisting members with insurance questions, benefit explanations, account information, and claims support. The role requires a balance of customer service skills and technical knowledge of healthcare systems, with opportunities for growth and development within the organization
Key Responsibilities:
- Serve as the initial point of contact for members, providing timely and professional resolution to inquiries and complaints.
- Master and utilize core healthcare systems such as HSP, HPS, HealthTrio, and Zelis to verify eligibility, review claims, and manage member accounts.
- Navigate foundational pillars of healthcare offerings, including Health Exchange, US Family Health Plan, and NCHD.
- Assist members with portal navigation, access, and benefit structure explanations.
- Maintain accurate and detailed documentation of all member interactions following audit-ready standards and prescribed workflows.
- Strive for first-call resolution to maximize member satisfaction.
- Participate in ongoing training to enhance skills in claims interpretation, premium payment processing, and multi-line service delivery.
- Demonstrate leadership competencies such as Leader of Self and Leader of Others as part of career progression.
Qualifications:
- High School Diploma or equivalent
- Strong customer service and communication skills.
- Basic understanding or willingness to learn healthcare claims, benefits, and insurance processes.
- Ability to quickly learn and master multiple internal systems and workflows.
- Detail-oriented with strong documentation and problem-solving skills.
- Commitment to professional growth and continuous learning.