What are the responsibilities and job description for the Member Services Specialist position at Global Healthcare IT?
Member Services Specialist
Summary:
The Member Services Specialist serves as a frontline ambassador for the health plan, delivering high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business.
As the initial point of contact, this role extends beyond basic call handling—Specialists are trained to navigate the foundational pillars of our healthcare offerings, including the Health Exchange, US Family Health Plan, and NCHD, with a strong emphasis on first-call resolution.
Specialists develop working knowledge of benefit structures, assist callers with portal navigation and access, and begin interpreting claims activity to support both member and provider inquiries. This position blends customer service excellence with technical skill-building, offering exposure to internal systems, regulatory protocols, and cross-functional workflows.
Specialists are expected to gain proficiency in core platforms used for eligibility verification, claims review, and member account management (e.g., HSP, HPS, HealthTrio). All interactions must be documented with a clear and concise recap of the call’s purpose, following prescribed workflows and audit-ready standards.
This role provides a structured pathway for advancement, with progressive training in claims interpretation, premium payment processing, and multi-line service delivery, laying the foundation for future specialization and leadership opportunities.
Responsibilities:
- Begin mastery of four core systems (e.g., HSP, HPS, HealthTrio, and Zelis) to independently resolve inquiries and complete calls with accuracy and confidence.
- Resolve member, provider, and broker inquiries effectively while maintaining a focus on first-call resolution.
- Assist with portal navigation and access, providing step-by-step guidance to ensure a positive user experience.
- Develop working knowledge of benefit structures across assigned lines of business.
- Support callers in understanding claims activity, including how services were processed and patient responsibility.
- Follow documented workflows and standard operating procedures to ensure consistency and compliance.
- Document all call activity with a clear summary of the interaction and resolution, using appropriate internal systems.
- Meet or exceed established performance metrics, including quality assurance standards and service level targets.
- Participate in ongoing training and coaching sessions to build expertise and stay informed about product updates and regulatory changes.
Demonstrate a commitment to service excellence, teamwork, and continuous improvement.
Job Types: Full-time, Contract
Pay: Up to $18.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Vision insurance
Education:
- High school or equivalent (Required)
Experience:
- Member Services Specialist: 1 year (Required)
- Customer service: 1 year (Required)
Ability to Commute:
- Irving, TX 75039 (Required)
Work Location: In person
Salary : $18