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We are looking for a dedicated Member Services Rep to join our client's team in Pearland, Texas, on a contract basis. This position focuses on supporting the Utilization Management department by ensuring accurate and timely processing of authorization requests while maintaining clear communication with providers and members. The role offers an opportunity to contribute to operational efficiency, regulatory compliance, and quality patient care in a health insurance environment.
Job Responsibility:
Handle inbound calls from providers, members, and facilities regarding authorization requests, status updates, and coverage questions
Review and process authorization requests received via phone, fax, and electronic systems
Create and document authorization cases accurately within utilization management systems or EHR platforms
Route cases requiring medical necessity review to clinical staff (RNs, LVNs, Medical Directors)
Communicate authorization determinations to providers and members in compliance with regulatory requirements
Maintain accurate, timely documentation to support compliance and operational standards
Collaborate with internal teams to ensure efficient case processing and resolution
Requirements:
1–3 years of healthcare experience (utilization management, insurance operations, or medical office preferred)
Experience handling high call volumes in a professional environment
Strong data entry and documentation accuracy
Ability to multitask in a fast-paced setting
Effective communication skills with providers, members, and internal teams
Basic understanding of authorization processes in healthcare or insurance
Experience with EMR/EHR or case management systems
Strong organizational and time management skills
Nice to have:
Experience in healthcare operations, managed care, or utilization management
Background supporting authorization processes and working with providers
Experience in health plans, medical offices, hospitals, or healthcare call centers preferred
Familiarity with EMR/EHR systems and healthcare workflows
What we offer:
medical, vision, dental, and life and disability insurance