Member Services Representative - Health Plan Admin

Christus Health; Irving (TX); Hybrid; USD 36,000 - 54,000; Full time

Job summary

CHRISTUS Health in Irving, TX is seeking a Customer Service Advocate to serve as a frontline ambassador for the health plan, resolving inquiries from members, providers, and brokers with a focus on first-call resolution.

You will navigate Health Exchange, US Family Health Plan, and NCHD, explain benefits, guide portal use, document interactions in the CRM, and support projects under leadership to deliver excellent service.

Qualifications

• High school diploma or GED required.
• Strong verbal and written communication skills.
• Ability to multitask in a fast-paced, metric-driven environment.
• Demonstrated attention to detail and data entry accuracy.
• Proficiency in Microsoft Office and ability to learn proprietary systems quickly.
• Team-oriented with a customer-first mindset.
• Willingness to participate in overtime and remote work when needed.
• HIPAA compliance during member/provider interactions.
• Experience in healthcare, insurance, or call center environments preferred.

Responsibilities

• Provides frontline support and resolves inquiries from members, providers, and brokers.
• Quotes basic eligibility and benefits for Medicare Advantage inquiries.
• Documents call interactions clearly in the CRM.
• Explains core benefits and eligibility using handbook terminology.
• Guides members through CHRISTUS website and member portal.
• Redirects providers to approved channels for eligibility and claims status.
• Maintains performance metrics: calls handled, average handle time, hold time, and schedule adherence.
• Advocates for beneficiaries to resolve issues with care.
• Supports and delivers assigned projects under leadership direction.

Skills

Communication skills

Multitasking

Attention to detail

Microsoft Office

Team collaboration

Education

High school diploma or GED

Tools

Microsoft Office Suite

Proprietary systems

Job description

Serves as a frontline ambassador for the health plan, delivering high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business. Provides support beyond basic call handling which includes navigating the foundational pillars of our healthcare offerings, including the Health Exchange, US Family Health Plan, and NCHD, with a strong emphasis on first-call resolution.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Resolve member, provider, or broker inquiries across Health Exchange, US Family Health Plan, and NCHD. Quote basic eligibility and benefits for Medicare Advantage inquiries, with emphasis on provider-facing interactions.
• Resolve routine inquiries during initial contact using standardized scripting, system navigation, and clear documentation.
• Document call interactions in the CRM with clarity, accuracy, and resolution details that support audit readiness and downstream coordination.
• Explain core benefits and eligibility using handbook-aligned language; assist members in understanding coverage and accessing services.
• Guide members through navigation of the CHRISTUS website and their individual member portal.
• Professionally redirect providers to approved electronic channels (portal, 270/271, 276/277) for eligibility and claims status, in alignment with policy.
• Maintain performance expectations, including total calls handled, average call handle time, average hold time compliance, and schedule adherence.
• Advocate on the part of the beneficiary to resolve any issue with care.
• Support and deliver assigned projects under leadership direction, contributing to team goals and operational excellence.

Job Requirements:

Education/Skills

• High school diploma or GED is required
• Strong verbal and written communication skills, with the ability to convey complex information clearly and professionally
• Ability to multitask and manage time effectively in a fast-paced, metric-driven environment
• Demonstrated attention to detail and accuracy in documentation and data entry
• Basic proficiency in Microsoft Office Suite (Word, Excel, Outlook) and ability to learn proprietary systems quickly
• Ability to work collaboratively in a team setting while independently managing assigned tasks
• Professional demeanor and customer-first mindset, with a focus on empathy, patience, and problem-solving
• Ability to participate in scheduled overtime during high-volume periods
• Ability to work remotely on scheduled work-from-home days and during unscheduled building closures (e.g., inclement weather, power outages, or emergency events), with reliable internet access and adherence to all remote work protocols.
• Demonstrate ability to interpret claim statuses in CRM, explain routine denial codes in plain language, and guide members to their EOBs for further detail and resolution.
• Ability to follow crisis call protocols with proficiency and care.
• Participate in progressive training modules and skill assessments that support career advancement within Member Services.
• Demonstrate understanding of member's rights and responsibilities, FWA, and remain HIPAA compliant during member/provider interactions.
• Provide customer service excellence through engagement, effective listening skills, patience, and desire to resolve the question/issue.

Experience

• Experience in customer service, ideally in healthcare, insurance, or call center environment

Licenses, Registrations, or Certifications

• None required

In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.