Member Service Representative

Capital District Physicians Health Plan Inc; City of Albany (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Member Service Representative to join their remote team. This role is pivotal in educating members and resolving service inquiries, ensuring clients understand their rights and responsibilities. You'll collaborate with various departments to provide comprehensive support, all while maintaining a high standard of professionalism. With a competitive hourly rate and a supportive work environment, this opportunity allows you to make a real difference in the community while enjoying flexible work arrangements and a comprehensive benefits package. If you're passionate about service and eager to contribute to a mission-driven organization, this role is for you.

Benefits

Health Coverage

Paid Time Off

Employee Assistance Programs

Flexible Work Arrangements

Qualifications

• One year of customer service experience required; two or more years preferred.
• Ability to interpret health plan contracts and schedules.

Responsibilities

• Educating members on the proper utilization of the Plan.
• Resolving service issues and addressing complaints.

Skills

Customer Service

Problem-Solving

Communication Skills

Attention to Detail

Education

High School Diploma or GED

Tools

Microsoft Word

Documentation Systems

Job description

Join CDPHP as a Member Service Representative

Grounded by a compelling mission, core values, and compassion for people, CDPHP offers a rewarding career in a supportive environment. Established in 1984, CDPHP is a physician-founded, member-focused, community-based not-for-profit health plan providing high-quality, affordable health insurance across New York. We value people, quality, innovation, and community, fostering a culture of belonging and diversity, equity, and inclusion. Employees are encouraged to make an impact through engagement and volunteer opportunities.

Position Overview

The Member Service Representative will be responsible for educating members, employer groups, brokers, and prospective members on the proper utilization of the Plan. The role involves resolving service issues, addressing complaints, and advising customers on their rights and responsibilities. The representative will collaborate with departments such as Marketing, Enrollment, Pharmacy, Provider Services, and Claims Operations to resolve inquiries, review eligibility, provide rates, assist with enrollments, and handle multiple product lines through system updates and communication via telephone and correspondence.

Qualifications

• High school diploma or GED required.
• Minimum of one year of customer service experience required; two or more years preferred.
• Experience with documentation systems preferred.
• Proficiency in Microsoft Word required.
• Strong problem-solving skills related to benefits, claims, appeals, enrollment, and billing issues.
• Ability to interpret health plan contracts, riders, and schedules.
• Excellent verbal and written communication skills, maintaining professionalism at all times.
• Attention to detail and ability to meet quality and productivity standards.
• Ability to complete system updates efficiently.

Employment Details

This is a remote position offering a competitive hourly rate of $20.00/hour, with shifts available from 9:30 am to 6 pm or 11:30 am to 8 pm. CDPHP provides a comprehensive benefits package, including health coverage, paid time off, employee assistance programs, and flexible work arrangements. Compensation is based on experience and qualifications, with potential for incentives and overtime.

Equal Opportunity Statement

CDPHP is an Equal Opportunity/Affirmative Action Employer. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, or other protected characteristics. All qualified applicants will be considered for employment without regard to these factors.