Member Services Representative

Job#: 3036468

Job Description:

The Member Services Representative serves as a primary point of contact for members, delivering high-quality, personalized support across a range of healthcare and insurance-related inquiries. This role is responsible for addressing questions related to enrollment, benefits, eligibility, billing, claims, and authorizations while ensuring a seamless and positive member experience.

Success in this position requires a balance of professionalism, empathy, and strong problem-solving skills in a fast-paced, customer-focused environment. The ideal candidate is detail-oriented, adaptable, and comfortable navigating multiple systems within a highly regulated industry.

Key Responsibilities

• Support members via phone, email, and other communication channels regarding benefits, claims, enrollment, and billing inquiries
• Provide clear, accurate guidance through complex healthcare and insurance processes
• Document all member interactions and ensure appropriate follow-up and resolution
• Collaborate with internal teams to resolve issues and escalate when necessary
• Meet or exceed performance metrics for quality, productivity, and response times
• Apply sound judgment to interpret policies and resolve member concerns
• Maintain working knowledge of healthcare regulations and internal systems
• Handle sensitive situations with empathy, professionalism, and a customer-first approach
• Ensure compliance with confidentiality and data privacy standards
• Manage workload effectively in a fast-paced, high-volume environment
  
  

Qualifications

• High School Diploma or GED required; some college preferred
• 2 years of customer service, call center, or administrative support experience
• Healthcare, Medicare, or health insurance experience strongly preferred
  
  

Core Skills

• Strong customer service, communication, and problem-solving abilities
• Ability to navigate multiple systems and tools efficiently
• Detail-oriented with strong organization and time management skills
• Adaptable with the ability to quickly learn new processes and regulations
• Comfortable working in remote or hybrid environments
  
  

Work Environment

• Fast-paced, metrics-driven environment
• Prolonged periods of sitting with frequent computer and phone use
• Moderate decision-making requiring independent judgment
• Strict adherence to confidentiality and compliance standards
  
  

The Member Services Representative provides personalized, high‑quality support to members by answering questions, resolving concerns, and coordinating with internal teams to ensure a positive service experience. This role requires strong communication skills, attention to detail, and the ability to manage tasks efficiently in a fast‑paced environment. The ideal candidate demonstrates empathy, professionalism, and a strong commitment to customer satisfaction.

Key Responsibilities

• Provide personalized service to members via phone, email, or in person regarding enrollment, benefits, billing, claims, eligibility, and authorization inquiries.
• Accurately document all member interactions, inquiries, and complaints in the tracking system and route items appropriately for follow‑up.
• Consistently meet or exceed departmental productivity, accuracy, and quality standards.
• Demonstrate a customer‑first mindset with empathy, active listening, and professional communication.
• Maintain working knowledge of health insurance guidelines, regulations, and internal systems.
• Use independent judgment and problem‑solving skills to resolve issues and interpret procedures.
• Maintain confidentiality of all member and business information in compliance with company and regulatory standards.
• Effectively manage time and workload in a high‑volume, fast‑paced call‑center environment.
  
  

Minimum Qualifications

Education

• High school diploma or GED required.
• Some college coursework preferred.
  
  

Experience

• At least 1 year of customer service experience, preferably in:
• A call center environment
• Administrative support
• Medicare or health insurance-related roles
  

Skills & Competencies

• Strong verbal and written communication skills.
• Knowledge of customer service best practices and phone system operations.
• Proficiency with Windows systems, basic software applications, and electronic documentation workflows.
• Ability to maintain a warm, empathetic, service‑oriented demeanor when interacting with members.
• Skilled in using standard office equipment, keyboarding, Wi‑Fi/VPN, and audio tools.
• Ability to quickly learn and apply health insurance policies, procedures, and regulatory requirements.
• Strong organizational and time management abilities.
• Ability to adapt to changing business needs, including remote or hybrid work environments.
• Commitment to maintaining confidentiality and complying with all regulatory standards.
  
  

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178.

Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Everforth Apex uses a virtual recruiter as part of the application process. Click here for more details. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Everforth Apex and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at https://www.apexsystems.com/privacy-policy

Everforth Apex Benefits Overview: Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6 months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Everforth Apex team member can provide.

Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

If you require an accommodation under the Americans with Disabilities Act to participate in an interview with a virtual recruiter or to use our website for a search or application, please contact our Benefits Department at [email protected] or 804-523-8228. Please note that this contact information is strictly to be used for medical ADA accommodations and that no other inquiries will be answered.

UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Everforth Apex Systems.

© 2026 Everforth, Inc. All rights reserved.

Everforth Apex Systems is part of the Commercial Segment of Everforth, Inc.

NYSE: EFOR

4400 Cox Road

Suite 200

Glen Allen, Virginia 23060

Everforth Apex is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Benefits Department at [email protected] or 804-523-8228. (Do not submit resumes or solicit consultants to this email address). UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Everforth Apex.