Member Services Representative - HP Member Services

CHRISTUS Health • Irving, TX

1d • Hybrid

About The Position

Serves as a frontline ambassador for the health plan, providing high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business. The role includes supporting the Health Exchange, US Family Health Plan, and NCHD, with a strong emphasis on first-call resolution.

The representative resolves routine inquiries using standardized scripting and system navigation, documents interactions accurately in the CRM, explains benefits and eligibility, and helps members access services and navigate online resources. The position also supports provider use of approved electronic channels and contributes to team projects and operational goals.

Requirements

• High school diploma or GED.
• Strong verbal and written communication skills, including the ability to convey complex information clearly and professionally.
• Ability to multitask and manage time effectively in a fast-paced, metric-driven environment.
• Attention to detail and accuracy in documentation and data entry.
• Basic proficiency in Microsoft Office Suite (Word, Excel, Outlook) and ability to learn proprietary systems quickly.
• Ability to work collaboratively in a team setting while independently managing assigned tasks.
• Professional demeanor and customer-first mindset, with empathy, patience, and problem-solving skills.
• Ability to participate in scheduled overtime during high-volume periods.
• Ability to work remotely on scheduled work-from-home days and during unscheduled building closures, with reliable internet access and adherence to remote work protocols.
• Ability to follow crisis call protocols.
• Understanding of members’ rights and responsibilities and FWA, and ability to remain HIPAA compliant during interactions.
• Experience in customer service, ideally in healthcare, insurance, or a call center environment.

Responsibilities

• Resolve member, provider, or broker inquiries across the Health Exchange, US Family Health Plan, and NCHD.
• Quote basic eligibility and benefits for Medicare Advantage inquiries, with emphasis on provider-facing interactions.
• Resolve routine inquiries during initial contact using standardized scripting and system navigation.
• Document call interactions in the CRM with clear, accurate resolution details that support audit readiness and downstream coordination.
• Explain core benefits and eligibility using handbook-aligned language and assist members with understanding coverage and accessing services.
• Guide members through the CHRISTUS website and their individual member portal.
• Redirect providers to approved electronic channels (portal, 270/271, 276/277) for eligibility and claims status, in alignment with policy.
• Meet performance expectations for total calls handled, average call handle time, average hold time compliance, and schedule adherence.
• Advocate on behalf of beneficiaries to resolve issues with care.
• Support and deliver assigned projects under leadership direction, contributing to team goals and operational excellence.
• Interpret claim statuses in the CRM, explain routine denial codes in plain language, and guide members to their EOBs for further detail and resolution.
• Follow crisis call protocols with proficiency and care.
• Participate in progressive training modules and skill assessments that support career advancement within Member Services.
• Demonstrate understanding of members’ rights and responsibilities, FWA, and HIPAA compliance during member and provider interactions.
• Provide customer service through engagement, effective listening, patience, and a commitment to resolving questions and issues.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED