Member & Provider Services Representative

About the Role:

We’re seeking dedicated, customer-focused individuals to join our Gravie Care Member & Provider Services Team. In this role, you’ll serve as a first point of contact for members and providers, delivering exceptional service via inbound calls and emails. You’ll support inquiries related to all aspects of health insurance: helping individuals navigate their plans, understand benefits, resolve claims issues, and more.

You Will:

• Deliver an outstanding, empathetic customer experience by making each interaction simple, helpful, and positive.
• Respond professionally to inbound inquiries from members and providers via phone and email.
• Ask thoughtful questions to fully understand the issue, then identify appropriate solutions or next steps. Accurately explain claims, benefits, eligibility, billing, provider networks, and prescription coverage using internal systems.
• Actively listen and demonstrate compassion, ensuring callers feel heard and supported.
• Record all interactions clearly and thoroughly in our Customer Relationship Management (CRM) system.
• Partner with internal departments, third-party vendors, and brokers/navigators to provide seamless resolution and support.
• Maintain a structured and reliable schedule; availability for extended hours during peak season (January–March) may be required.
• Uphold the Gravie CARE service model (Compassion, Advocacy, Resolution, Education) in every interaction.
• Embody our core values: Be authentic. Stay curious. Think creatively. Focus on outcomes.
• Ensure compliance with all privacy, confidentiality, and security protocols, including HIPAA and other regulatory standards. Consistently meet or exceed performance expectations in areas such as call quality, adherence, RSAT (Customer Satisfaction), After Call Work, and Call Answered%.

You Bring:

• 1–2 years of experience in customer service or a call center environment.
• A passion for helping people, with a track record of resolving complex customer concerns using active listening, creative problem-solving, and empathy.
• Strong written and verbal communication skills, with the ability to summarize information clearly and effectively.
• High reliability and a strong commitment to adhering to a structured work schedule.
• Excellent attention to detail and strong organizational skills.
• Experience entering and updating information in electronic systems or databases.
• Proficiency navigating computers, including multitasking across multiple platforms and systems, with solid typing skills.
• Self-motivation and the ability to work effectively with individuals from diverse backgrounds and roles.
• The ability to learn quickly and follow established processes accurately and efficiently.
• A results-driven mindset, comfortable working in a fast-paced and ever-evolving environment.

Extra Credit:

• Previous experience in health insurance, healthcare, or related fields.
• Familiarity with Microsoft Office and Google Suite.
• Active Health Insurance Producer License or willingness to obtain licensure if required.
• Experience working with Medicare, Medicaid, or Marketplace plans.

Work Environment:

• This role is remote. Candidates must have access to a quiet, professional workspace and reliable high-speed internet.
• A high level of focus, professionalism, and independence is expected, particularly in a remote environment.