Member Services Representative II

Member Service Representative II

Location: Sacramento, CA (Hybrid)
Pay Range: $22.00–$25.00 per hour

Western Health Advantage is seeking a compassionate, customer-focused Member Service Representative II to serve as a primary point of contact for members, providers, brokers, and plan partners. In this role, you will assist with benefit, eligibility, billing, and claims-related inquiries while delivering exceptional service and resolving complex member concerns.

We are looking for someone who demonstrates empathy, patience, and a genuine desire to support members as they navigate their healthcare needs. Strong listening skills, attention to detail, and the ability to communicate clearly and effectively are essential for success in this role. Candidates should be comfortable problem-solving, investigating issues thoroughly, and collaborating with internal and external partners to ensure timely and accurate resolutions.

If you thrive in a fast-paced environment, enjoy building trust with customers, and take pride in making a meaningful difference in people's lives, we encourage you to apply.

Key Responsibilities

• Respond to member inquiries via phone, email, chat, and fax regarding Commercial, Exchange, and Individual plans.
• Research and resolve member concerns, including complex cases and urgent access-to-care issues.
• Assist members, providers, brokers, and plan partners with benefits, claims, billing, and plan information.
• Accurately document interactions, appeals, and grievances according to established procedures.
• Collaborate with internal departments and external partners to ensure timely issue resolution.
• Support and mentor team members by providing guidance on benefits, policies, and systems.
• Assist with training and call shadowing for new Member Service Representatives.
• Promote member self-service resources and online tools.
• Meet departmental performance, quality, and attendance standards.

Qualifications

• High School Diploma or equivalent required.
• Minimum two (2) years of call center or customer service experience.
• Healthcare or HMO experience preferred.
• Strong communication, problem-solving, and customer service skills.
• Proficiency with basic computer applications, including email, word processing, and spreadsheets.

Western Health Advantage values and supports the unique talents and strengths that each employee brings to our organization. Collaborating with the best and brightest professionals creates a dynamic and fulfilling work environment while enabling us to provide exceptional service to our members.

Western Health Advantage is committed to providing equal employment opportunities to employees and applicants for employment on the basis of merit and without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, medical condition, genetic information, marital status, ancestry, military or veteran status, or any other basis protected by federal, state, or local law.

Please beware of phishing scams that solicit interviews or promote work-from-home opportunities while posing as legitimate employers. Western Health Advantage will never ask applicants for a credit card, send a check, or request any form of payment as part of the hiring process. If you believe you have been the victim of a scam, please report the incident to the Federal Trade Commission and select the “Rip-offs and Imposter Scams” reporting option.