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Customer Service Advocate - Call Center

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MMC Group LP

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Location:
United States , Houston

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Category:
Call Center

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Contract Type:
Not provided

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Salary:

19.69 USD / Hour
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Job Description:

We are seeking a dedicated and service-driven Member Services Representative to join a fast-paced healthcare support team in Houston. This role serves as the primary point of contact for members, providers, and partners by handling inbound inquiries related to healthcare benefits, eligibility verification, claims status, authorization updates, and general account support. The ideal candidate is detail-oriented, thrives in a high-volume call environment, and can confidently resolve complex issues while delivering exceptional customer service while maintaining strict confidentiality and compliance standards.

Job Responsibility:

  • Manage incoming calls related to member benefits, eligibility verification, claim status updates, prior authorizations, and service concerns
  • Research and resolve claims-related inquiries by identifying issues, reviewing claim details, and determining appropriate next steps
  • Submit reconsideration requests and escalation documentation when necessary
  • Provide first-call resolution whenever possible to ensure a positive customer experience
  • Accurately document all interactions, updates, and follow-up actions within internal CRM and case management systems
  • Route inquiries electronically to the appropriate departments while maintaining complete and accurate records
  • Track recurring issues and communicate trends to leadership for operational improvements
  • Maintain compliance with privacy standards, confidentiality requirements, and internal service protocols
  • Collaborate with internal teams including claims, eligibility, authorizations, and operations support to ensure timely issue resolution
  • Deliver professional, courteous, and solution-focused service in every interaction

Requirements:

  • High school diploma or GED required
  • Minimum of 2 years of customer service or call center / contact center experience
  • At least 1 year of healthcare-related experience supporting benefits, claims, eligibility, or authorizations preferred
  • Strong working knowledge of Microsoft Office including Word, Excel, and Outlook
  • Ability to work independently with minimal supervision
  • Strong data entry accuracy and moderate to advanced computer proficiency
  • Excellent written and verbal communication skills
  • Strong problem-solving ability with attention to detail
  • Ability to manage multiple priorities in a fast-paced environment

Nice to have:

  • Experience supporting healthcare plans, insurance operations, or managed care environments
  • Familiarity with claims review, eligibility verification, and authorization workflows
  • Experience working within CRM systems and healthcare service platforms
  • Strong understanding of confidentiality standards and compliance requirements
What we offer:
  • Medical, dental, and vision coverage
  • Life and disability insurance
  • Additional voluntary benefits

Additional Information:

Job Posted:
May 05, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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