Membership Experience Representative (CSR) – Health Insurance

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)

• First‑call resolution
• Call quality and compliance scores

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‑Linguial Rep, the applicant must speak, read, write fluently in both languages. For Spanish‑English Bi‑Linguial Rep, the applicant must speak, read, write fluently in both languages. For Mandarin‑English Bi‑Linguial Rep, the applicant must speak, read, write fluently in both languages. For Cantonese‑English Bi‑Linguial Rep, the applicant must speak, read, write fluently in both languages.