Hospital Member Services Agent

Prestige Hospital System
Advancing new knowledge and improving health outcomes through research

Competitive compensation
Medical Insurance
Dental Insurance
Vision Insurance
Life Insurance
Flexible Schedule
Job Stability
Career growth
If you are passionate, thrive in a fast-paced environment and are ready to take your career to the next level, we would love to hear from you.

Job Details

As a Consulting Hospital Member Services Agent, you will be the first point of contact for members and patients, providing exceptional customer service and resolving issues efficiently. This role requires handling inbound calls, documenting member interactions, assisting with healthcare-related inquiries, and collaborating with internal departments to ensure service delivery. This is a 22-week contract position with a standard business hours shift (M-F 8-5 PST) and occasional overtime when required. You will be working remotely and must have prior experience in a remote work environment. The bill rate for this position is $52.

Responsibilities

Your key responsibilities will include:

1. Answering and managing inbound member and patient calls professionally and empathetically.
2. Educating members about healthcare benefits, coverage, eligibility, referrals, authorizations, provider networks, claims, and member rights and responsibilities.
3. Researching, troubleshooting, and resolving member issues, escalating complex concerns when appropriate.
4. Facilitating warm transfers and coordinating with internal departments to ensure seamless service.
5. Conducting follow-up communication and callbacks to ensure issue resolution and member satisfaction.
6. Serving as a liaison between members, patients, providers, and contracted health plans as needed.
7. Accurately documenting all member interactions, requests, updates, and resolutions in the managed care information system.
8. Maintaining compliance with HIPAA, confidentiality requirements, and all applicable healthcare regulations.
9. Supporting departmental quality improvement initiatives and recommending process improvements when appropriate.

Qualifications

To qualify for this role, you must have:

1. A High School Diploma, GED, or equivalent.
2. A minimum of 3 years of customer service, member services, or related experience in a healthcare environment.
3. Strong verbal and written communication skills, including professional email etiquette, proper grammar, accurate documentation, clear formatting, and attention to detail.
4. Knowledge of healthcare terminology and managed care principles.
5. Proficiency with computer systems, Microsoft Office applications, and data entry.
6. Strong problem-solving, organizational, and multitasking skills.
7. Ability to handle sensitive situations with empathy, professionalism, and confidentiality.
8. Ability to work effectively in a fast-paced environment with high call volumes, interruptions, and changing priorities.
9. Ability to collaborate as part of a team and provide cross-coverage as needed.

Preferred qualifications include:

1. Experience with EPIC Tapestry, CRM systems, or similar healthcare technology platforms.
2. Experience working in managed care, health plans, or healthcare customer service environments.