Membership Experience Representative (CSR) – Health Insurance

Position Title: Membership Experience Representative (Customer Service)
Employment Type: Full-Time / Part-Time (Remote)
Department: Member Services
Reports To: Member Services Supervisor

Role Overview

The Membership Experience Representative serves as the primary point of contact for health insurance members, delivering exceptional service and support. This role focuses on resolving inquiries related to benefits, claims, billing, and general account concerns while ensuring a positive member experience.

Key Responsibilities

• Handle inbound calls, emails, and chats from members
• Assist with benefits explanations, claims status, billing inquiries, and provider searches
• Resolve member issues efficiently and professionally
• Accurately document interactions in CRM or member management systems
• Educate members on plan features and coverage details
• Escalate complex or sensitive issues as needed
• Adhere to HIPAA and data privacy regulations
• Maintain high customer satisfaction and service quality
  
  

Qualifications

• 1+ year experience in customer service or healthcare support
• Health insurance experience preferred
• Strong communication and problem-solving skills
• Ability to handle high call volumes calmly and professionally
• Tech-savvy with CRM and ticketing systems
• Reliable internet and distraction-free workspace
  
  

Preferred Skills

• Call center or virtual CSR experience
• Knowledge of medical terminology and insurance processes
• Experience supporting Medicare, Medicaid, or commercial plans
  
  

Key Performance Indicators (KPIs)

• Customer satisfaction (CSAT)
• First-call resolution
• Call quality and compliance scores
• Average handling time (AHT)

Compliance & Confidentiality:

• Must strictly comply with HIPAA, PHI handling standards, and Avocado VA policies
• Completion of mandatory compliance and security training is required
  
  

Why Join Avocado VA:

• Work with established US healthcare and insurance clients
• Long-term role stability with growth opportunities
• Ongoing training, support, and upskilling
• Professional virtual work environment
  
  

Note:

For Vietnamese-English Bi-Lingual Rep, the applicant must speak,read,write fluently in both languages.

For Spanish-English Bi-Lingual Rep, the applicant must speak,read,write fluently in both languages.