Customer Service Advocate - Call Center

MMC Group•Houston, TX

4d•Onsite

About The Position

We are seeking a dedicated and service-driven Member Services Representative to join a fast-paced healthcare support team in Houston. This role serves as the primary point of contact for members, providers, and partners by handling inbound inquiries related to healthcare benefits, eligibility verification, claims status, authorization updates, and general account support. The ideal candidate is detail-oriented, thrives in a high-volume call environment, and can confidently resolve complex issues while delivering exceptional customer service while maintaining strict confidentiality and compliance standards.

Requirements

High school diploma or GED required
Minimum of 2 years of customer service or call center / contact center experience
At least 1 year of healthcare-related experience supporting benefits, claims, eligibility, or authorizations preferred
Strong working knowledge of Microsoft Office including Word, Excel, and Outlook
Ability to work independently with minimal supervision
Strong data entry accuracy and moderate to advanced computer proficiency
Excellent written and verbal communication skills
Strong problem-solving ability with attention to detail
Ability to manage multiple priorities in a fast-paced environment

Nice To Haves

Experience supporting healthcare plans, insurance operations, or managed care environments
Familiarity with claims review, eligibility verification, and authorization workflows
Experience working within CRM systems and healthcare service platforms
Strong understanding of confidentiality standards and compliance requirements

Responsibilities

Manage incoming calls related to member benefits, eligibility verification, claim status updates, prior authorizations, and service concerns
Research and resolve claims-related inquiries by identifying issues, reviewing claim details, and determining appropriate next steps
Submit reconsideration requests and escalation documentation when necessary
Provide first-call resolution whenever possible to ensure a positive customer experience
Accurately document all interactions, updates, and follow-up actions within internal CRM and case management systems
Route inquiries electronically to the appropriate departments while maintaining complete and accurate records
Track recurring issues and communicate trends to leadership for operational improvements
Maintain compliance with privacy standards, confidentiality requirements, and internal service protocols
Collaborate with internal teams including claims, eligibility, authorizations, and operations support to ensure timely issue resolution
Deliver professional, courteous, and solution-focused service in every interaction