Blending
Care
and Expertise
Member Services Specialist
Location: Irving, TX
Date Posted: 04 Dec, 2025
Job Summary
The Member Services Specialist serves as a frontline ambassador for the health plan, delivering high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business. As the initial point of contact, this role extends beyond basic call handling—Specialists are trained to navigate the foundational pillars of healthcare offerings, including the Health Exchange, US Family Health Plan, and NCHD, with a strong emphasis on first-call resolution.
Specialists develop working knowledge of benefit structures, assist callers with portal navigation and access, and begin interpreting claims activity to support both member and provider inquiries. This position blends customer service excellence with technical skill-building, offering exposure to internal systems, regulatory protocols, and cross-functional workflows. Specialists are expected to gain proficiency in core platforms used for eligibility verification, claims review, and member account management (e.g., HSP, HPS, HealthTrio). All interactions must be documented with a clear and concise recap of the call’s purpose, following prescribed workflows and audit-ready standards.
This role provides a structured pathway for advancement, with progressive training in claims interpretation, premium payment processing, and multi-line service delivery, laying the foundation for future specialization and leadership opportunities.
Key Responsibilities
- Meet expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Begin mastery of four core systems (e.g., HSP, HPS, HealthTrio, and Zelis) to independently resolve inquiries.
- Deliver resolution-focused support to members, providers, and brokers across multiple lines of business.
- Assist callers with portal navigation, access, and benefit structure inquiries.
- Interpret claims activity to support member and provider questions.
- Document all interactions with clear and concise recaps, following prescribed workflows and audit-ready standards.
- Collaborate with cross-functional teams to ensure seamless service delivery.
- Adhere to regulatory protocols and organizational policies.
Required Qualifications
- High school diploma or equivalent; associate or bachelor’s degree preferred.
- Minimum of 1–2 years of customer service or healthcare-related experience.
- Strong communication and interpersonal skills.
- Ability to learn and master multiple internal systems (HSP, HPS, HealthTrio, Zelis).
- Detail-oriented with strong organizational and documentation skills.
- Ability to work in a fast-paced environment with a focus on first-call resolution.
Preferred Qualifications (if any)
- Prior experience in health insurance, managed care, or healthcare administration.
- Familiarity with claims processing and benefit structures.
- Experience with electronic health or member management systems.
Certifications (if any)
- None required; customer service or healthcare-related certifications are a plus.
Education: High School
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