Member Services Representative
About the role
Pride Health is hiring a Hybrid Customer Service Representative to support our client's medical facility in Pearland, TX 77584. This is a 6+ month contract assignment (Possibility of conversion or extension) and a great way to start working with a top-tier healthcare organization!
Job Details
- Location: Pearland, TX 77584
- Job Type: 6+ months (Possibility of extension or conversion)
- Schedule: Flexible availability between 8:00 AM–8:00 PM, 7 days a week, including possible weekend coverage
- Pay Rate: $13.50/hr. on W2
Job Summary
Provides phone-based customer service support to health plan members by assisting with benefits, eligibility, claims, providers, pharmacy services, appeals, grievances, and general plan questions. Responsible for researching and resolving concerns, using de-escalation skills, documenting interactions, navigating multiple systems, and delivering excellent member service.
Responsibilities
- Handle high-volume inbound member calls.
- Assist with benefit, claims, provider, pharmacy, appeal, and grievance inquiries.
- Resolve member concerns using empathy, problem-solving, and de-escalation skills.
- Document interactions accurately while maintaining HIPAA/PHI compliance.
- Navigate multiple systems and support AEP call volume.
Required Qualifications
- Minimum 5 years of healthcare experience required, preferably in Medicare advantage plans, Health insurance, member services, claims, benefits, or customer service.
- Strong communication, multitasking, problem-solving, and de-escalation skills.
- Ability to protect confidential member information and navigate multiple systems.
- Ability to work independently in a remote environment after training.
Remote Requirements
- Reliable high-speed wired internet (cable, fiber, or DSL); mobile hotspots and cellular 5G internet are not permitted.
- Basic technical skills to troubleshoot connectivity issues, set up equipment, and understand computer installation requirements.
- Ability to use dual monitor.
Benefits
Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors.