Member Services Representative

TEKsystems • Los Angeles, CA

13d • $23 - $23 • Onsite

About The Position

We are seeking a dedicated and service-driven Member Services Representative to join a fast-paced healthcare support team. In this role, you will serve as the primary point of contact between members, providers, and health plans—ensuring a seamless and positive healthcare experience. This position is ideal for individuals with a strong customer service background in healthcare who thrive in call center environments and enjoy problem-solving while making a meaningful impact on patient care.

Requirements

• Minimum 2 years of customer service experience, preferably in: Healthcare plan, IPA (Independent Practice Association), Medical group call center
• Strong knowledge of: HMO structures, CMS (Centers for Medicare & Medicaid Services) guidelines, DMHC (Department of Managed Health Care) regulations
• Familiarity with medical coding and claims terminology
• Call center operations
• Customer service excellence
• Medical records management
• Patient care coordination
• Insurance verification
• Excellent written and verbal communication skills
• Professional and pleasant phone demeanor
• Strong attention to detail and problem-solving abilities
• Ability to multitask in a fast-paced environment
• Proficiency in Microsoft Office (Word, Excel, Outlook)

Responsibilities

• Act as the main liaison between members, medical providers, and health plans
• Handle high-volume inbound and outbound calls in a call center environment
• Respond to member inquiries regarding claims, referrals, and eligibility
• Assist with insurance verification and coordination of healthcare services
• Review and maintain accurate medical records and documentation
• Provide guidance on healthcare processes and care management support
• Ensure compliance with healthcare regulations and internal policies
• Deliver exceptional customer service while resolving issues promptly

Benefits

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed