Job Description

Health New England is looking for a knowledgeable Member Services Representative to join the Member Services team in Springfield, MA.

This is an opportunity to join a collaborative team where your communication skills, problem-solving abilities, and commitment to exceptional customer service directly contribute to a positive member experience.

RESPONSIBILITES

The Member Services Representative serves as a trusted resource for members, providers, and employer groups—providing knowledgeable, compassionate service and helping resolve questions and concerns from start to finish.

This is an opportunity to join a collaborative team where your communication skills, problem-solving abilities, and commitment to exceptional customer service directly contribute to a positive member experience.

Key Responsibilities include:

• Research and resolve complex inquiries by phone, mail, email, and fax.
• Educate members, employers, and providers on benefits, policies, procedures, and available resources.
• Investigate and resolve complex pharmacy-related questions in partnership with the Pharmacy Services team and use the RxClaims system.
• Conduct new member outreach calls to help members understand and successfully navigate their benefits.
• Process member transactions, including PCP changes, demographic updates, ID card requests, and requests for membership materials.
• Partner with Enrollment, Claims, Health Services, Pharmacy, Legal, and Sales teams to ensure member concerns are resolved accurately and efficiently.
• Maintain established individual and departmental service and quality standards.
• Protect member confidentiality and ensure all documentation and inquiries are handled in accordance with regulatory and organizational requirements.

SCHEDULE:

• Full-time, 40 hours a week
• 8:30am-5pm during training (7 weeks)
• After completion of training- schedule will be 9:30am-6:00pm

LOCATION:

• 1 Monarch Place
• Springfield, MA

QUALIFICATIONS

• Associates degree, required
• At least 2 years of customer service or call center experience within managed care, insurance, healthcare, or a related industry or an equivalent combination of education and experience
• Demonstrated commitment to providing exceptional customer service.
• Strong listening, verbal, and written communication skills.
• Excellent problem-solving and critical-thinking abilities.
• Strong attention to detail with the ability to manage multiple priorities.
• Effective interpersonal, negotiation, and conflict-resolution skills.
• Good organizational skills and the ability to work effectively in a fast-paced environment.
• Proficiency with computers; experience with Microsoft Office products preferred.

Education:

Associates Degree (Required)

Certifications:

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

$21.95 - $25.22 - $29.82

Equal Employment Opportunity Employer