Member Services Representative

Type: Current Job Openings

General Purpose

Handles inquiries by telephone and/or email from providers in a customer service center.  Troubleshoots and resolves provider complaints.  Ensures that responses to inquiries are completed timely and according to established service and quality standards.

Essential Duties & Responsibilities

  • Works toward quality initiatives.
  • Resolves provider inquiries and complaints via written and/or telephonic communication in a timely and accurate manner.
  • Records all inquiries into the computer system for a permanent record.
  • Initiates adjustments for services not properly processed by forwarding to appropriate area.
  • Utilizes and understands computer screens to provide accurate answers.
  • Works closely with co-workers when necessary to research answers to inquiries.
  • Elevates issues to next level as appropriate.
  • Strives to resolve provider concerns in a single interaction.
  • Meets all production, quality and adherence standards. Attends all required training sessions.
  • Other duties as assigned.

Other Duties & Responsibilities

As needed: handles telephone monitor, switchboard and front desk.

Supervisory Duties


Job Qualifications

Knowledge, Skill & Ability
  • Must possess good telephone skills
  • Must be able to comprehend and explain BCBS contract language
  • Must be able to comprehend provider contract language.
  • Demonstrates good organizational and time management skills with strong communication skills
  • Is able to deal with demanding, stressful situations
Education, Licensure, or Formal Training

High school degree or equivalent. Company will provide job related training pertaining to company unique information.



Prior Customer Service experience is preferred.

Equipment & Environment

Material & Equipment Directly Used

Computer, telephone, fax machine

Working Environment / Physical Activities

Works in Member Call Center sitting at desk for entire work day. Must man phones with periodic relief.

Access to Protected Health Information (PHI)

Access to PHI is broad due to job function requirement of responding to customer inquiries relative to claims payments, eligibility, contract benefits and other inquiries.

Note: Position summary shown may not include ALL of the necessary knowledge, skill, and ability requirements.

Blue Cross Blue Shield of Wyoming
EOE M/F/Vet/Disabled Employer