Call Center Representative (Member Services) - USFHP

Agence PROvidence; Renton (WA); Sur place; USD 42 000 - 54 000; Plein temps

Résumé du poste

Strong customer service, critical thinking, and prioritization are essential as you navigate an ACD-driven environment and coordinate with clinics, providers, and internal teams to resolve issues and ensure satisfaction.

Qualifications

• 2 years of experience in healthcare field customer service position.
• Experience in handling benefits, eligibility, referrals, claims, billing, and coverage options is preferred.

Responsabilités

• Assist members and providers with questions about benefits, eligibility, referrals, claims, billing, appointment access and coverage options.
• Use an automated call distribution system to manage a high volume of inbound inquiries, providing timely, accurate service through phone, written and electronic channels.
• Process correspondence, respond to written inquiries, and document interactions for effective tracking and follow-up.
• Guide enrollees through complaint, grievance, and appeals processes and collaborate with providers and internal teams to support positive outcomes.

Connaissances

Customer service

Critical thinking

Prioritization

Communication

Formation

Post secondary education

Outils

ACD system

Description du poste

Be the voice our heroes trust when they need help.

At PacMed’s US Family Health Plan (USFHP), every interaction matters. As a Member Services Representative, you will serve as a trusted resource for uniformed service members, retirees, and their families, helping them understand their benefits, navigate the healthcare system, and resolve concerns with professionalism, empathy, and accuracy.

In this frontline role, you will assist members and providers with questions about benefits, eligibility, referrals, claims, billing, appointment access, and coverage options. Using an automated call distribution (ACD) system, you will manage a high volume of inbound inquiries while delivering timely, accurate service through phone, written, and electronic communication channels. You will also process correspondence, respond to written inquiries, and document interactions to ensure effective tracking and follow-up.

Success in this position requires strong customer service skills, critical thinking, and the ability to prioritize tasks while working independently. You will guide members through complaint, grievance, and appeals processes, help new enrollees understand their coverage, and collaborate with providers, clinics, and internal teams to support positive outcomes. Strong communication skills, attention to detail, and a calm, solution-focused approach are essential.

Experience with health insurance, managed care, medical terminology, or TRICARE benefits is helpful, but equally important is a commitment to delivering exceptional service with compassion and respect.

Required qualifications:

• 2 years of experience in healthcare field customer service position.

Preferred qualifications:

• Post secondary education.
• 2 years of experience in healthcare field customer service position in an HMO setting.
• Call Center Experience

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.