Also referred to as: Health Plan Member Services Representative, Health Plan Member Support Representative
Requirements and Responsibilities

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.

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