Member Services Agent

Member Services Agent 3363686

• Hourly pay: $35/hr
• Worksite: Leading medical institution (Los Angeles, CA 90045 - Remote)
• W2 Employment, Group Medical, Dental, Vision, Life, Retirement Savings Program, PSL
• 40 hours/week, 5 Month Assignment

A leading medical institution is seeking a Member Services Agent to provide exceptional customer service and support to members and patients, and to serve as the primary point of contact for healthcare-related inquiries, resolving issues, educating members on benefits and coverage, documenting interactions, and collaborating with internal teams to ensure timely, accurate, and high-quality service.

Member Services Agent Responsibilities:

• Respond to high-volume inbound member and patient calls, provide education on healthcare benefits, eligibility, referrals, authorizations, claims, provider networks, and member rights, and resolve issues through research, troubleshooting, follow-up, and escalation when appropriate.
• Accurately document member interactions, research findings, call outcomes, requests, discrepancies, and resolutions within managed care systems while maintaining organized, audit-ready records and adhering to established service protocols.
• Coordinate with internal departments, providers, health plans, and other stakeholders to facilitate warm transfers, resolve member concerns, and ensure seamless service delivery and member satisfaction.
• Maintain compliance with HIPAA, confidentiality requirements, healthcare regulations, and departmental quality standards while contributing to quality improvement initiatives and achieving customer service and productivity goals.
• Utilize healthcare systems, CRM tools, Microsoft Office applications, and departmental resources to manage multiple priorities in a fast-paced, high-volume environment while providing cross-coverage and administrative support as needed.

Member Services Agent Qualifications:

• 3+ years of customer service, member services, or related experience in a healthcare environment.
• Knowledge of healthcare terminology and managed care principles.
• Experience documenting research, call outcomes, discrepancies, and next steps in an organized, audit-ready manner.
• Proficiency with Microsoft Office applications, computer systems, and accurate data entry.
• Experience working in a remote modality.
• Experience with EPIC Tapestry, CRM systems, or similar healthcare technology platforms is preferred.
• Experience working in managed care, health plans, or healthcare customer service environments is preferred.

Shift:

• 8:00 am to 5:00 PM PST, and occasional overtime as required.

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