Member Services Representative - HP Member Services

CHRISTUS Health System; Irving (TX); Hybrid; USD 36,000 - 45,000; Full time

Job summary

CHRISTUS Health in Irving, TX is seeking a compassionate Member Services specialist to serve as a frontline ambassador for our health plan. You will resolve inquiries from members, providers, and brokers across Health Exchange, US Family Health Plan, and NCHD, prioritizing first-call resolution and accurate documentation.

You will navigate our member portal and CHRISTUS website, explain benefits, and guide callers through eligibility questions.

Qualifications

• High school diploma or GED required.
• Strong written and spoken communication skills.
• Ability to multitask in a fast-paced environment.
• Attention to detail in documentation and data entry.
• Proficient with Microsoft Office; quick learner of proprietary systems.
• Team player with a customer-first mindset.
• Empathy, patience, and problem-solving focus.
• Able to work overtime during high-volume periods.
• Ability to work remotely on scheduled days and adhere to remote work protocols.
• Ability to interpret claim statuses in CRM and explain EOB information.

Responsibilities

• Resolve inquiries across Health Exchange, US Family Health Plan, and NCHD.
• Provide knowledge on eligibility and benefits for Medicare Advantage.
• Address routine inquiries using scripting and system navigation.
• Document calls clearly in the CRM for audit readiness.
• Explain core benefits and guide members to services.
• Direct providers to approved electronic channels for eligibility and claims.
• Meet performance metrics for calls, handle time, and adherence.
• Advocate for beneficiaries to resolve issues with care.
• Support projects and contribute to team goals.
• Maintain HIPAA compliance during interactions.

Skills

Verbal communication

Written communication

Multitasking

Attention to detail

Microsoft Office

Teamwork

Customer service mindset

Empathy

Overtime readiness

Remote work adaptability

Education

High school diploma or GED

Tools

CRM system

Job description

Summary

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.

Work Schedule

8AM - 5PM Monday-Friday

Work Type

Full Time