Member solutions represenative

Company Description

Humana is a leading health and well-being company focused on helping people achieve their best health through personalized care, innovative insurance products, and supportive services. The organization serves millions of members across the United States through Medicare, Medicaid, and commercial health plans. Humana emphasizes a culture of compassion, integrity, and collaboration, encouraging team members to bring forward ideas that improve member experiences. The company invests in technology, training, and professional development to support high-quality service and long-term career growth. Team members are encouraged to contribute to inclusive, member-centered solutions that make healthcare easier to understand and navigate. Role Description This full-time remote Member Solutions Representative role is responsible for supporting Humana members by responding to inquiries about benefits, claims, coverage options, and plan details via phone, chat, or email. The person in this role will research account information, resolve issues, and provide clear, accurate explanations in a professional and empathetic manner. Daily activities include documenting interactions in internal systems, following established procedures and compliance guidelines, and escalating complex cases to the appropriate teams when needed. The Member Solutions Representative will collaborate with teammates and other departments to ensure timely resolution of member concerns, while meeting quality, productivity, and service-level expectations. The role also involves participating in training, coaching, and feedback sessions to continually improve service skills and product knowledge.

Qualifications

• Strong customer service and communication skills, with the ability to listen actively, explain complex information clearly, and show empathy in challenging situations.
• Proficiency with computers and common office software, including working in multiple systems or screens, accurate data entry, and quick navigation of online tools.
• Problem-solving and critical-thinking abilities, including researching member issues, identifying root causes, and following through to resolution using established procedures.
• Organizational and time-management skills, with the ability to manage a high volume of calls or messages, prioritize tasks, and meet performance metrics in a remote environment.
• Ability to learn and apply health plan, insurance, or healthcare-related information; prior experience in health insurance, call centers, or member services is a plus.
• Comfort working independently in a remote setting while staying engaged with a virtual team, including reliable internet access and a suitable, distraction-free workspace.
• High school diploma or equivalent required; additional education or certifications in healthcare, business, or related fields are beneficial.
• Commitment to confidentiality, compliance with regulatory standards, and treating all members and colleagues with respect and fairness.