Member Service Representative

Talentify; San Antonio (TX); On-site; USD 36,000 - 48,000; Full time

Job summary

Talentify in Texas seeks a Member Services Representative to serve as a liaison between members and providers, resolving inquiries by phone and ensuring HIPAA compliance across operations. Ideal candidates have a high school diploma, some college coursework in business or healthcare, and experience in health plan environments or problem resolution.

This role emphasizes empathy, clear communication, and adherence to regulatory guidelines while delivering accurate information to Community First

Qualifications

• High school graduation or equivalency is required.
• One year of college-level courses in business, healthcare administration or related fields is preferred.
• Minimum of one-year HMO experience is preferred.
• Healthcare problem resolution experience is preferred.

Responsibilities

• Acts as a liaison to members and providers to resolve member services issues.
• Provides information to Community First Health Plan members by phone.
• Ensures HIPAA-related policies are followed in all Member Services operations.

Skills

HIPAA compliance knowledge

Education

High school diploma or equivalent

One year of college-level courses in business/healthcare administration or related fields

Job description

POSITION SUMMARY/RESPONSIBILITIES

Serves as a liaison to members and providers in resolving member services issues. Provides information to Community First Health Plan members by phone. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies in regards to all aspects of operations within Member Services.

EDUCATION/EXPERIENCE

High school graduation or its equivalency is required. One year of college level courses in business, health care administration or related courses is preferred. Minimum of one-year HMO experience is preferred. Health care problem resolution experience is preferred.