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Member Service Representative

Customer Service | Miami, FL | Full Time

Job Description

Innovative TPA service, PayerFusion Holdings LLC seeks a personable, efficient and committed Member Service Representative. Candidates are to be proficient in claim processing technology, which coupled with our unique healthcare cost containment methodologies will be have a sharp advantage in the field. Our ranks exemplify excellence and are rewarded and compensated accordingly.

We are a service-based company in the healthcare industry creating a full-featured software suite from scratch. Innovation drives our creation, as we are a progressive team, aiming to streamline the health field. Our ground-breaking approach is matched by our multi-cultural and professional team.


  • Main responsibilities will be liaising between providers and insurance companies to provide excellent service to insured members.
  • Must be quality driven and a self-starter that is responsible and with excellent follow up skills.
  • Excellent communications skills via email and telephone (must be proficient in good telephone use and etiquette skills) to communicate with clients and interact with medical providers and our in-house case management department.
  • Must be proficient in all functions of computer office use including email, excel, crystal reporting and other day to day software tools
  • Must be fully proficient in the use of the English language- written and spoken communication


  • We prefer someone with ICD 10 and CPT 4 knowledge and an understanding of the healthcare forms (UB 04 and CMS 1500).
  • Preferably must have previous medical field expertise in working in a health insurance company or HMO plan with authorizations, patient referrals and or customer service sales.

Bonus Points:

  • We provide excellent health and dental insurances.
  • We also provide of time off during the year (vacation/sick and holiday) and a pleasant working environment