Member Services Representative

Member Services Representative

The Member Services Representative provides personalized, high-quality support to members by answering questions, resolving concerns, and coordinating with internal teams to ensure a positive service experience. This role requires strong communication skills, attention to detail, and the ability to manage tasks efficiently in a fast-paced environment. The ideal candidate demonstrates empathy, professionalism, and a strong commitment to customer satisfaction.

Key Responsibilities

• Provide personalized service to members via phone, email, or in person regarding enrollment, benefits, billing, claims, eligibility, and authorization inquiries.
• Accurately document all member interactions, inquiries, and complaints in the tracking system and route items appropriately for follow-up.
• Consistently meet or exceed departmental productivity, accuracy, and quality standards.
• Demonstrate a customer-first mindset with empathy, active listening, and professional communication.
• Maintain working knowledge of health insurance guidelines, regulations, and internal systems.
• Use independent judgment and problem-solving skills to resolve issues and interpret procedures.
• Maintain confidentiality of all member and business information in compliance with company and regulatory standards.
• Effectively manage time and workload in a high-volume, fast-paced call-center environment.

Minimum Qualifications

Education

• High school diploma or GED required.
• Some college coursework preferred.

Experience

• At least 1 year of customer service experience, preferably in:
• A call center environment
• Administrative support
• Medicare or health insurance-related roles

Skills & Competencies

• Strong verbal and written communication skills.
• Knowledge of customer service best practices and phone system operations.
• Proficiency with Windows systems, basic software applications, and electronic documentation workflows.
• Ability to maintain a warm, empathetic, service-oriented demeanor when interacting with members.
• Skilled in using standard office equipment, keyboarding, Wi‑Fi/VPN, and audio tools.
• Ability to quickly learn and apply health insurance policies, procedures, and regulatory requirements.
• Strong organizational and time management abilities.
• Ability to adapt to changing business needs, including remote or hybrid work environments.
• Commitment to maintaining confidentiality and complying with all regulatory standards.

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.