Member Service Representative III

Purpose

Join us in building healthier communities.

About the Role

Western Health Advantage is seeking an experienced Member Service Representative (MSR) III to serve as a primary point of contact for members, providers, brokers, and plan partners. In this senior-level call center role, you will handle complex, high-level inquiries related to health plan benefits, policies, and procedures while supporting and mentoring other Member Service Representatives.

Responsibilities

• Responding to member inquiries related to Commercial, Exchange, and Individual plans via phone, email, chat, and fax
• Providing in-person support to walk-in members as needed
• Resolving complex or high-level issues that require research, investigation, or coordination with internal departments or external partners
• Supporting other Member Service Representatives by answering questions and providing guidance on plan rules, benefits, policies, and system navigation
• Aiding in urgent or sensitive cases, including those involving access to care or referral to the Member Relations Unit
• Assisting with training support and call shadowing for new Member Service Representatives
• Assisting members, providers, brokers, and plan partners with claims-related billing questions as needed
• Collaborating with inter- and intra-department teams to ensure timely resolution of member issues within established timeframes
• Informing members about the Advantage Referral Program, the WHA website, and available online self-service tools
• Accurately documenting and referring appeals and grievances in accordance with departmental protocols
• Managing difficult or emotional customer situations with professionalism, empathy, and discretion
• Maintaining departmental standards related to quality, productivity, and attendance
• Reporting system issues or emerging call drivers to the Member Service Supervisor or Manager
• Participating in meetings related to system upgrades or changes and sharing relevant information with the team
• Performing special projects and additional duties as assigned

Qualifications

• High School Diploma or equivalent
• Minimum of 3 years of experience working in a call center with increasing levels of responsibility
• Intermediate computer skills, including email, databases, word processing, spreadsheets, and graphics
• Strong written and verbal communication skills
• Ability to read, write, speak, and understand the primary language(s) used in the workplace

Preferred Qualifications

• Previous experience working in the healthcare industry, particularly within an HMO environment

Why Join Western Health Advantage?

At Western Health Advantage, our Member Services team plays a vital role in shaping the member experience. As an MSR III, you’ll have the opportunity to make a meaningful impact by resolving complex issues, supporting your peers, and ensuring members receive accurate, compassionate, and timely service. Western Health Advantage is committed to providing equal employment opportunities to employees and applicants for employment on the basis of merit and without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, medical condition, genetic information, marital status, ancestry, military or veteran status, or any other basis made unlawful by federal or state law. Western Health Advantage values and supports the unique talents and strengths that each employee brings to our organization.