Member Services Representative

Location: Akron, OH 44305
Pay Rate: $18.00 – $20.00 per hour
Schedule: Monday–Friday | 8:00 AM – 5:00 PM
Type: Full-Time

We are seeking a Member Services Representative to provide high-quality customer support for members in a healthcare environment. This role focuses on resolving inquiries related to benefits, eligibility, billing, claims, enrollment, and authorizations while ensuring a professional, empathetic, and compliant customer experience.

Role Overview

The Member Services Representative serves as the primary point of contact for members, delivering personalized support through phone, electronic communication, and occasionally in-person interactions. This role requires strong communication skills, attention to detail, and the ability to navigate healthcare and insurance-related systems while maintaining confidentiality and service quality standards.

Key Responsibilities

Member Support & Service

• Provide personalized assistance to members regarding enrollment, benefits, eligibility, billing, claims, and authorization inquiries.

• Respond to questions and resolve concerns in a timely, professional, and empathetic manner.

• Deliver service via phone, email, and other electronic communication channels.

• Ensure all interactions reflect a customer-first, respectful, and solution-oriented approach.

Documentation & Case Management

• Accurately document all member inquiries, issues, and complaints in tracking systems.

• Route cases appropriately for resolution and follow-up.

• Maintain detailed and accurate records in accordance with company and regulatory requirements.

Systems & Technical Support

• Utilize computer systems and platforms including Windows-based applications and internal healthcare systems (e.g., Amisys, Macess).

• Operate standard office equipment including computer, headset, and communication tools.

• Manage workflows using VPN, Wi-Fi, and secure system access protocols.

Compliance & Quality Standards

• Maintain strict confidentiality of member health information and business data (HIPAA compliance).

• Adhere to all regulatory, departmental, and organizational policies and procedures.

• Meet or exceed performance metrics for quality, productivity, and service standards.

Problem Solving & Communication

• Exercise independent judgment to resolve member issues and interpret procedures appropriately.

• Communicate clearly and effectively both verbally and in writing.

• Balance professionalism with empathy and a calm, customer-focused demeanor.

• Collaborate with management and internal departments to resolve complex issues.

Required Qualifications

• High School Diploma or GED required (college experience preferred)

• Minimum 2+ years of customer service, call center, or administrative support experience

• Experience in healthcare, Medicare, or health insurance strongly preferred

• Strong verbal and written communication skills

• Proficiency with computer systems, data entry, and standard office applications

• Ability to maintain confidentiality and handle sensitive information

• Strong organizational and time management skills in a fast-paced environment

Preferred Qualifications

• Experience working with Medicare or health insurance systems

• Familiarity with call center environments and performance metrics

• Prior experience using healthcare platforms such as Amisys or Macess

• Background in remote or hybrid customer service environments

Physical & Work Requirements

• Ability to sit for extended periods of time

• Ability to lift up to 20 pounds as needed

• Occasional bending, stooping, and stretching

• Manual dexterity for computer and phone use

Ideal Candidate

The ideal candidate is a professional, service-oriented individual who excels in high-volume customer support environments. This person demonstrates empathy, strong communication skills, attention to detail, and the ability to navigate healthcare systems while maintaining compliance and accuracy.

Why This Role

This position offers the opportunity to support members in a meaningful healthcare-focused environment while developing expertise in insurance operations, customer service, and healthcare systems. It is well suited for individuals seeking stable weekday hours and structured career growth in the healthcare services field.