Member Service Representative III

Role: Member Service Representative III in a hybrid setting, responsible for providing advanced support to members, providers, brokers, and plan partners. Key Responsibilities: Handle complex inquiries related to health plan benefits, policies, and procedures via phone, email, chat, and in-person. Resolve high-level issues through research and coordination, support and mentor other representatives, assist with claims and billing questions, educate members on available tools and programs, document appeals and grievances, and manage difficult customer situations with professionalism. Participate in system upgrades, special projects, and team collaboration to ensure timely resolution of member issues. Qualifications and Skills: Minimum 3 years call center experience, strong communication skills, intermediate computer skills, and a high school diploma or equivalent. Healthcare experience, especially in an HMO environment, is preferred. Qualifications: Customer service professional capable of handling complex cases with tact, professionalism, and empathy, committed to quality and departmental standards.