Member Services Specialist

Work Setup: Onsite

Education Requirement: High School Diploma (must submit PDF proof for submission)

Experience Requirement: Minimum 2 years customer service experience in healthcare, insurance, or call center environments

Location: Irving, Texas, United States

Pay Rate: $18 per hour

The Member Services Specialist serves as the primary liaison between members and the health plan, delivering high-quality support through phone, written communication, and in-person interactions. The role requires a strong understanding of healthcare benefits, products, and insurance processes, ensuring members receive accurate information and timely resolution.

This position supports multiple healthcare programs—including Health Exchange, US Family Health Plan, an—and emphasizes first-call resolution. Specialists will learn to navigate internal systems (HSP, HPS, HealthTrio), assist members with portal access, verify eligibility, and interpret basic claims activity. All customer interactions must be documented clearly and concisely for regulatory and audit purposes.

• High School Diploma (mandatory; must be submitted as part of client documentation)
• At least 2 years of customer service experience in healthcare, health insurance, or a call center
• Strong understanding of healthcare benefits and coverage
• Ability to handle inbound and outbound calls professionally
• Basic knowledge of claims, eligibility, and member account management
• Proficiency in internal systems or willingness to train (HSP, HPS, HealthTrio)
• Strong attention to detail and ability to document interactions accurately
• Excellent verbal and written communication skills
• Ability to work independently and collaboratively in a fast-paced environment

• Provide accurate and efficient assistance to members and providers by researching plan coverage, benefits, and inquiries
• Serve as the frontline representative for multiple product lines and healthcare programs
• Record all customer contact—phone, walk-in, written—in the Member Information System (MIS)
• Assist in training or re-training new and current staff members as required
• Maintain proper documentation of all communication to ensure a clear audit trail
• Handle all inbound calls and initiate outbound calls when necessary to resolve issues
• Triage calls to Utilization Management, Provider Relations, or other relevant departments
• Process incoming written correspondence in a timely and professional manner
• Navigate and utilize essential systems such as Microsoft Word, Microsoft Excel, and internal MIS platforms

• Minimum Required: High School Diploma

• Healthcare & Health Insurance Knowledge
• Claims Adjusting / Insurance Claims Support
• Member Services / Customer Service
• Strong Communication Skills
• Documentation & MIS Proficiency
• Microsoft Word and Excel