Member Service Representative
Pride Health, Houston, TX, United States
Job Title: Member Services Representative – Call Center (Bilingual)
Location: Houston, TX 77086
Shift: 8-hour shift between 7:00 AM – 6:00 PM (Monday–Friday)
Duration: 3 months with a strong possibility of extension
Pay Range: $15 – $18/hr
Key Responsibilities: Handle inbound calls from members/providers regarding eligibility, benefits, claims, and referrals Research and resolve issues while coordinating with internal teams Assist with appointment scheduling and care navigation Document interactions in systems (EPIC, MACESS, etc.) Ensure HIPAA compliance and maintain confidentiality Provide empathetic, high-quality customer service in a fast-paced environment
Required Qualifications Minimum 1–2 years of call center experience Medicaid or managed care experience required Ability to explain medical benefits and coverage Familiarity with call center metrics (AHT, QA, adherence, FCR) Strong communication, multitasking, and problem-solving skills Bilingual (English/Spanish) required
Screening Requirements Candidates must be able to answer: Call center experience and environment Medicaid/health plan experience Familiarity with benefits, eligibility, and claims Call center metrics handled Systems used (EPIC, CRM, etc.) Comfort handling high call volumes and escalations
“Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors”
Key Responsibilities: Handle inbound calls from members/providers regarding eligibility, benefits, claims, and referrals Research and resolve issues while coordinating with internal teams Assist with appointment scheduling and care navigation Document interactions in systems (EPIC, MACESS, etc.) Ensure HIPAA compliance and maintain confidentiality Provide empathetic, high-quality customer service in a fast-paced environment
Required Qualifications Minimum 1–2 years of call center experience Medicaid or managed care experience required Ability to explain medical benefits and coverage Familiarity with call center metrics (AHT, QA, adherence, FCR) Strong communication, multitasking, and problem-solving skills Bilingual (English/Spanish) required
Screening Requirements Candidates must be able to answer: Call center experience and environment Medicaid/health plan experience Familiarity with benefits, eligibility, and claims Call center metrics handled Systems used (EPIC, CRM, etc.) Comfort handling high call volumes and escalations
“Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors”