Member Service Representative

Capital Blue Cross

. Provide efficient, courteous, professional service to members, providers, group administrators, brokers, Plan personnel, and the general public .

Posted 9/17/2026full-timeRemote • Pennsylvania • United StatesJunior💰 $17 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong customer service skills with the ability to analyze and resolve inquiries related to benefits, claims, and billing while maintaining compliance with HIPAA regulations. Proficient in using PC systems and Microsoft Office Suite to track and manage customer interactions effectively.

Highest-signal resume keywords

Customer Service ExperienceHIPAA ComplianceAnalytical SkillsVerbal and Written Communication SkillsMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Inquiry ResolutionBenefits AnalysisClaims ProcessingBilling ManagementEnrollment ProceduresProblem-SolvingPolicy InterpretationData TrackingCustomer Inquiry ResearchTrend Reporting

Soft Skills

ProfessionalismFlexibilityOrganizational Skills

Tools & Technologies

Interactive Voice Response SystemsAutomated Call Distribution SystemsFacetsInquiry Control System

Industry Keywords

Protected Health InformationCustomer SatisfactionMarketing SupportHealth FairsOpen Enrollment

Tech Stack

Tools & technologies

React

About the role

Key responsibilities & impact

Provide efficient, courteous, professional service to members, providers, group administrators, brokers, Plan personnel, and the general public
Respond to inquiries received by telephone, fax, written correspondence, email, internet messenger, and personal interviews
Address enrollment, billing, benefits, and claims inquiries for various coverage types
Research and analyze customer inquiries using policies, procedures, PC systems, manuals, and Image
Resolve routine and moderately complex benefits, claims, billing, enrollment, COBRA, Medicare Secondary Payor, and related issues
Provide clear instructions to appropriate Plan areas for issue resolution
Contact internal and external entities to obtain information and initiate necessary action
Respond verbally or in writing with accurate and timely information
Monitor inquiries for timely and accurate resolution and customer satisfaction
Update Facets or Inquiry Control System records to track inquiry actions and status
Report inquiry trends to management
Support Marketing personnel and brokers by researching and communicating customer information
Participate in marketing activities such as health fairs, seminars, open enrollment, and on-site visits

Requirements

What you’ll need

High school diploma or G.E.D.
1 year customer service experience
Ability to understand and interpret detailed policies and procedures and apply them to various situations
Thorough understanding of Capital Blue Cross’s responsibility to maintain privacy of Protected Health Information as required by HIPAA
Ability to work independently, remain flexible, and react appropriately to changing job assignments and work environments
Effective and professional verbal and written communication skills
Analytical, organizational, and problem-solving skills
Ability to use telephone equipment systems such as Interactive Voice Response and Automated Call Distribution
Familiarity with a PC and Microsoft Office Suite
Ability to perform sedentary work involving sitting, talking, hearing, keying, repetitive motions, and close visual inspection of documents and monitors

Benefits

Comp & perks

Medical, Dental & Vision coverage
Retirement Plan
Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Flexible environment
Training and continuing education
Community volunteering opportunities