Healthcare Member Services Specialist

SGS Consulting; Lansing (MI); On-site; USD 34,000 - 50,000; Full time

Job summary

SGS Consulting seeks a dedicated customer service professional to respond to inquiries, educate members on healthcare policies, and maintain accurate inquiry history. You will work within HIPAA guidelines, handle escalations, and collaborate with internal departments to resolve issues.

The role requires strong communication, problem-solving, and the ability to manage multiple tasks with a focus on service excellence. Flexible shifts may be required, and ongoing training is provided.

Qualifications

• Minimum 2 years of recent Customer Service or Call Center experience within the last 3 years.
• Demonstrates integrity, patience, maturity, empathy, tact and diplomacy.
• Strong problem-solving, flexibility, good judgment, and service excellence.
• Proficient in using a PC and Microsoft programs.
• Basic understanding of health insurance delivery systems and claims billing.
• Ability to work flexible shifts, including evenings and weekends when required.

Responsibilities

• Respond to inquiries by telephone, mail and in person; research and answer inquiries, complaints and appeals following department standards, policies and procedures; direct inquiries to supporting departments for action and resolution.
• Educate members on policies, procedures, product offerings, benefit plans and coverage related to HAP products.
• Document all inquiries to track history and trends.
• Maintain confidentiality per Privacy and HIPAA regulations.
• Attend training and development to enhance skills and performance.
• Manage workflow inbox and cases to ensure timely response and follow-up.
• Interact with support departments to meet member needs.
• Develop relationships with inter-departments and stay updated on policy changes affecting servicing of members/customers.
• Attend training and continuing education offered by Customer Service to maintain skills.
• Interact with providers and staff to obtain information for resolving inquiries and complaints.
• Ensure compliance with department and corporate standards and procedures.
• Suggest process improvements based on observations and trends in customer interactions.
• Coordinate with departments on projects, enrollment periods, outreach activities and initiatives.
• Perform other related duties as assigned.

Skills

Customer service experience

Dependable

Integrity and empathy

Problem solving and service excellence

PC fluency and Microsoft programs

Understanding of HMO/PPO/POS and claim

Flexible shifts and overtime

Education

Associate’s degree

Medical Terminology course

Tools

Microsoft Office

Job description

SGS Consulting seeks a dedicated customer service professional to respond to inquiries, educate members on healthcare policies, and maintain accurate inquiry history. You will work within HIPAA guidelines, handle escalations, and collaborate with internal departments to resolve issues.

The role requires strong communication, problem-solving, and the ability to manage multiple tasks with a focus on service excellence. Flexible shifts may be required, and ongoing training is provided.