Member Service Representative
HybridPearland, Texas, United States
Job Summary
Handle high-volume inbound member calls, assisting with benefits, eligibility, claims, provider, pharmacy, appeal, and grievance inquiries. Resolve member concerns using empathy, problem-solving, and de-escalation skills while documenting interactions accurately to maintain HIPAA/PHI compliance. Navigate multiple systems to support AEP call volume. Requires minimum 5 years of healthcare experience, preferably in Medicare advantage plans, and strong communication and multitasking abilities. Must work independently in a remote environment with reliable high-speed wired internet, dual monitors, and basic technical troubleshooting skills. Training occurs onsite at KCA Pearland Administrative Office before transitioning to remote or hybrid work. Flexible availability between 8:00 AM–8:00 PM, seven days a week, including possible weekend coverage during AEP.
Required Qualifications
- Minimum 5 years of healthcare experience
- Strong communication skills
- Multitasking skills
- Problem-solving skills
- De-escalation skills
- Ability to protect confidential member information
- Ability to navigate multiple systems
- Ability to work independently in a remote environment
- Reliable high-speed wired internet (cable, fiber, or DSL)
- Basic technical skills to troubleshoot connectivity issues
- Ability to use dual monitors
- Availability between 8:00 AM–8:00 PM, 7 days a week, including possible weekend coverage
Desired Qualifications
- Experience in Medicare advantage plans
- Experience in Health insurance
- Experience in member services
- Experience in claims
- Experience in benefits
- Experience in customer service
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