Member Services Representative addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls, or written questions. Being a Member Services Representative provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Member Services Representative works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Member Services Representative typically requires 1-3 years of related experience, or may need 0 years of experience with additional specialized training and/or certification.