Member Services Representative

Pride Health; Pearland (TX); Hybrid; USD 17,000 - 21,000; Full time

Job summary

Pride Health is hiring a Hybrid Customer Service Representative to support our client’s medical facility in Pearland, TX 77584. This is a 6+ month contract assignment with the possibility of conversion or extension, and a strong entry point into a top-tier healthcare organization.

The role provides phone-based customer service for health plan members, handling benefits, eligibility, claims, and provider inquiries.

Qualifications

• Minimum 5 years of healthcare experience required, preferably in Medicare advantage.
• Strong communication, multitasking, problem-solving, and de-escalation skills.
• Ability to protect confidential member information and navigate multiple systems.
• Ability to work independently in a remote environment after training.

Responsibilities

• Assist with benefit, claims, provider, pharmacy, appeal, and grievance inquiries.
• Resolve member concerns using empathy, problem-solving, and de-escalation skills.
• Document interactions accurately while maintaining HIPAA/PHI compliance.
• Navigate multiple systems and support AEP call volume.

Skills

Healthcare experience

Customer service

HIPAA compliance

Job description

Pride Health is hiring a Hybrid Customer Service Representative to support our client’s medical facility in Pearland, TX 77584. This is a 6+ month contract assignment (Possibility of conversion or extension) and a great way to start working with a top-tier healthcare organization!

• Location:Pearland, TX 77584
• Job Type: 6+ months(Possibility of extension or conversion)
• Schedule: Flexible availability between 8:00 AM-8:00 PM, 7 days a week, including possible weekend coverage
• Pay Rate: $13.50/hr. on W2

*Offered pay rate will be based on education, experience, and healthcare credentials.

Job Summary

Provides phone-based customer service support to health plan members by assisting with benefits, eligibility, claims, providers, pharmacy services, appeals, grievances, and general plan questions. Responsible for researching and resolving concerns, using de-escalation skills, documenting interactions, navigating multiple systems, and delivering excellent member service.

Key Responsibilities

• Assist with benefit, claims, provider, pharmacy, appeal, and grievance inquiries.
• Resolve member concerns using empathy, problem-solving, and de-escalation skills.
• Document interactions accurately while maintaining HIPAA/PHI compliance.
• Navigate multiple systems and support AEP call volume.

Required Qualifications

• Minimum 5 years of healthcare experience required, preferably in Medicare advantage. plans, Health insurance, member services, claims, benefits, or customer service.
• Strong communication, multitasking, problem-solving, and de-escalation skills.
• Ability to protect confidential member information and navigate multiple systems.
• Ability to work independently in a remote environment after training.

Remote Requirements

• Reliable high-speed wired internet (cable, fiber, or DSL); mobile hotspots and cellular 5G internet are not permitted.
• Basic technical skills to troubleshoot connectivity issues, set up equipment, and understand computer installation requirements.
• Ability to use dual monitor.

#PHC

For workers in the United States, PrideGlobal and it's affiliates offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity

PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment

PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates : Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.