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Member Services Specialist

  • TX, Irving

  • 01/21/2026

  • Contract

  • Active

Job Description:

  • Job Summary
    We are seeking a professional and customer-focused Member Services Specialist (Onsite) to serve as a frontline ambassador for the health plan. This role delivers high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business. Specialists are trained to navigate core healthcare offerings—including the Health Exchange, US Family Health Plan, and NCHD—with a strong emphasis on first-call resolution. The position blends customer service excellence with technical skill-building, offering exposure to internal systems, regulatory protocols, and cross-functional workflows.

    Key Responsibilities
    1. Serve as the initial point of contact for members, providers, and brokers.
    2. Navigate and support inquiries related to benefit structures, portal access, and claims activity.
    3. Document all interactions with clear and concise recaps, following prescribed workflows and audit-ready standards.
    4. Gain proficiency in core platforms used for eligibility verification, claims review, and member account management (e.g., HSP, HPS, HealthTrio, Zelis).
    5. Assist with problem identification and resolution across departments.
    6. Mentor and orient new staff in skill development and professional behavior.
    7. Prioritize and delegate work assignments to ensure completion of member service activities.
    8. Comply with regulatory requirements, policies, procedures, and standards of practice.
    9. Participate in progressive training for claims interpretation, premium payment processing, and multi-line service delivery.

    Required Qualifications
    1. High School Diploma or equivalent.
    2. Strong communication and interpersonal skills.
    3. Ability to learn and navigate multiple healthcare systems and platforms.
    4. Customer service experience with a focus on resolution and professionalism.
    5. Basic computer proficiency.
    6. Must have at least 2 years of recent experience in the specialty within the past 2 years.

    Preferred Qualifications (if any)
    1. Prior experience in healthcare, insurance, or member services.
    2. Familiarity with claims processing and benefit structures.

    Certifications (if any)
    1. None required; customer service or healthcare-related certifications are a plus.

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