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Under the supervision of the Member Services Supervisor and direction of the Member Services Manager, the Member Services Representative is responsible for conducting welcome calls to new members and responding to inquiries from members and providers regarding plan benefits, policies, the Member Portal, and claims issues. This role focuses on delivering timely, accurate information and facilitating appropriate resolutions. The representative will regularly interact with members and service providers to resolve complex issues, interpret policies and procedures, explain benefits, and support overall service excellence.

Essential Duties and Responsibilities

• Communicate directly with members and providers to identify and resolve healthcare service concerns.
• Serve as a member advocate by promoting timely complaint and issue resolution while upholding professional standards.
• Provide accurate and detailed responses to member inquiries and assist with complaints and grievances in line with policy and regulatory requirements.
• Respond to urgent matters with prompt and thorough follow-up to ensure issues are resolved effectively.
• Foster positive relationships with members, providers, and internal departments through effective communication.
• Investigate, resolve, and escalate member/provider issues as needed.
• Document member feedback and track deviations from service standards, reporting to management as appropriate.
• Prepare and submit reports as directed.
• Maintain accurate and confidential records using internal systems.
• Log all member and provider interactions appropriately using internal tracking tools.
• Answer calls within required timeframes while maintaining a high quality of service.
• Support member retention efforts, including conducting satisfaction surveys.
• Provide accurate, up-to-date plan information to members.
• Assist with training newly hired Member Services Representatives as needed.
• Support scheduling of medical appointments and transportation services for members.
• Participate in special projects as assigned by management.
• Organize departmental records and reference materials.
• Use computer systems for data analysis, reporting, documentation, and project evaluations.
• Perform other related duties as assigned.
• Comply with all organizational policies and procedures related to job duties and employment.

Employment Standards

Education and Experience:

• High school diploma or equivalent required.
• At least two (2) years of recent experience in a customer service role or similar field, with strong problem-solving and decision-making abilities.
• Excellent telephone etiquette and communication skills are essential.

Commitment to Diversity: As an equal opportunity employer committed to meeting the needs of a multi-generational and multicultural workforce, Key Staffing recognizes that a diverse staff, reflective of our community, is an integral and welcome part of a successful and ethical business. We hire local talent at all levels regardless of race, color, religion, age, national origin, gender, gender identity, sexual orientation, or disability and actively foster inclusion in all forms both within our company and across interactions with clients, candidates, and partners.