Member Services Representative, Sr.

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Member Services Representative, Sr. is responsible for providing customer service to healthcare plan members. Explains coverage details, confirms eligibility, verifies claim status, and may resolve billing issues. Being a Member Services Representative, Sr. directs patients to in-network doctors and explains the authorization process for specialized care. Researches issues and escalates as appropriate. Additionally, Member Services Representative, Sr. maintains confidentiality per HIPAA guidelines. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Member Services Representative, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Member Services Representative, Sr. typically requires 3-5 years of related experience.