Member Services Representative

Capital Health Plan • Tallahassee, FL

9d • Onsite

About The Position

We are seeking a Member Services Representative to serve as a key point of contact for Capital Health Plan members and the community. This role is responsible for responding to high‑volume inquiries, providing accurate information regarding health plan benefits and services, and assisting with issue resolution to ensure a positive member experience. The Member Services Representative answers inbound calls, documents interactions in system databases, researches and resolves member concerns, and collaborates with internal teams to address inquiries related to eligibility, benefits, referrals, and services. This role plays a critical part in ensuring inquiries and complaints are handled accurately, professionally, and within established timeframes.

Requirements

• Associate's degree from an accredited two-year college or technical school, or equivalent education and experience
• Minimum of one year of related experience (call center, medical office, or customer service environment preferred)
• Ability to communicate clearly and professionally with members, staff, and the public by phone and in written communication
• Strong problem-solving skills with the ability to research and resolve member inquiries
• Ability to manage a high volume of calls while maintaining accuracy and professionalism
• Strong data entry and documentation skills, with the ability to track and follow up on member interactions
• Ability to work within established policies, procedures, and service timelines

Nice To Haves

• Experience working in a call center or healthcare customer service environment
• Knowledge of health plan benefits, eligibility, or referral processes
• Experience handling and resolving member complaints or escalations
• Familiarity with customer service systems or call tracking software
• Strong interpersonal skills and the ability to de-escalate concerns in a professional manner

Responsibilities

• Answer inbound calls
• Document interactions in system databases
• Research and resolve member concerns
• Collaborate with internal teams to address inquiries related to eligibility, benefits, referrals, and services
• Handle inquiries and complaints accurately, professionally, and within established timeframes

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree