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Alternate job titles: Health Plan Member Services Director

Directs and coordinates all aspects of the health maintenance organization (HMO) member services department. Plans and directs policies and objectives for addressing member inquiries. Establishes service quality goals for the department and implements strategies to meet these goals. Typically requires a bachelor's degree. Typically reports to top management. Manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep more...



The Health Plan Member Services Director plans and directs policies and objectives for addressing member inquiries. Directs and coordinates all aspects of the health maintenance organization (HMO) member services department. Being a Health Plan Member Services Director typically requires a bachelor's degree. Establishes service quality goals for the department and implements strategies to meet these goals. In addition, Health Plan Member Services Director typically reports to top management. The Health Plan Member Services Director manages a departmental sub-function within a broader departmen more...


Alternate job titles: Health Plan Member Services Manager

Responsible for daily activities in the member services function for a health plan or health maintenance organization (HMO). Collects data on member inquiries and service requests and conducts analysis to identify trends and recommend solutions. Ensures service representatives follow established policies for addressing member inquiries and meet service quality goals. Manages the recruitment, hiring, training, scheduling, and performance management of staff. Requires a bachelor's degree. Typically reports to a head of unit/department. Manages subordinate staff in the day-to-day performance of t more...


Alternate job titles: Health Plan Member Services Support Team Leader

Supervises a group of member services representatives that address health plan or HMO member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for researching more complex questions, investigating the cause of the issue, and responding to members on escalated issues. Assists with hiring, training, ongoing monitoring and QA, performance evaluations and any corrective actions of member services representatives. Requires a high school diploma or its equivalent. Typically reports to a mana more...



Alternate job titles: Health Plan Member Services Representative | Health Plan Member Support 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. Provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Requires a high school diploma or its equivalent. Typically reports to a supervisor or manager. Gains or has attained full proficiency in a specific area of discipline. Works under moderate supe more...


Alternate job titles: Health Plan Member Services Senior Representative | Health Plan Member Support Senior Representative

Addresses more complex health plan or HMO 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 and written requests. Provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Requires a high school diploma or its equivalent. Typically reports to a supervisor or manager. Has gained proficiency in multiple competencies relevant to the job more...



Alternate job titles: Health Plan Member Support Representative

The Health Plan Member Services Representative is responsible for receiving, responding to, and directing member phone calls, or written questions. Addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Being a Health Plan Member Services Representative maintains confidentiality per HIPAA guidelines. Provides available information upon request and researches or escalates issues as appropriate. In addition, Health Plan Member Services Representative requires a high school diploma or its more...


The Health Plan Member Services Manager collects data on member inquiries and service requests and conducts analysis to identify trends and recommend solutions. Responsible for daily activities in the member services function for a health plan or health maintenance organization (HMO). Being a Health Plan Member Services Manager manages the recruitment, hiring, training, scheduling, and performance management of staff. Ensures service representatives follow established policies for addressing member inquiries and meet service quality goals. In addition, Health Plan Member Services Manager requi more...


Alternate job titles: Member Services Representative, Sr. | Health Plan Member Support Senior Representative

The Health Plan Member Services Senior Representative is responsible for receiving, responding to, and directing member phone calls and written requests. Addresses more complex health plan or HMO member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Being a Health Plan Member Services Senior Representative maintains confidentiality per HIPAA guidelines. Provides available information upon request and researches or escalates issues as appropriate. In addition, Health Plan Member Services Senior more...



Alternate job titles: Member Services Supervisor

The Health Plan Member Services Support Team Leader is responsible for researching more complex questions, investigating the cause of the issue, and responding to members on escalated issues. Supervises a group of member services representatives that address health plan or HMO member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Being a Health Plan Member Services Support Team Leader requires a high school diploma or its equivalent. Assists with hiring, training, ongoing monitoring and QA, per more...


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