| Member Services Representative Job Description |
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| The following is a full job description for Member Services Representative. Here are the requirements and responsibilities for Member Services Representative along with statistics. If after reading this page you determine that Member Services Representative is not the position you are looking for, you may want to try one of these similar titles: Member Services Representative, Sr., Member Services Director, Member Services Manager, Member Experience Specialist, Membership Services Representative II, Member Services Supervisor, Member Education Coordinator, Membership Services Representative I, Professional Services Manager |
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| Requirements and Responsibilities For Member Services Representative |
| Responsible for providing customer service to healthcare plan members. Explains coverage details, confirms eligibility, verifies claim status, and may resolve billing issues. Directs patients to in-network doctors and explains the authorization process for specialized care. Researches issues and escalates as appropriate. Maintains confidentiality per HIPAA guidelines. Requires a high school diploma or equivalent. Typically reports to a supervisor. Works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. Typically requires 1-3 years of related experience. |
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| Also referred to as: Health Plan Member Services Representative, Health Plan Member Support Representative, Member Services Representative I |
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| Similar Jobs: Member Services Representative, Sr., Member Services Director, Member Services Manager, Member Experience Specialist, Membership Services Representative II, Member Services Supervisor, Member Education Coordinator, Membership Services Representative I, Professional Services Manager |
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| Level of Education: Member Services Representative Salaries with a High School Diploma or Technical Certificate, Member Services Representative Salaries with an Associate's Degree, Member Services Representative Salaries with a Bachelor's Degree, Member Services Representative Salaries with a Master's Degree or MBA, Member Services Representative Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Edu., Gov't. & Nonprofit, Healthcare, Insurance | |
