Hiring: Member Service Representative II (Hybrid) Company: CareFirst BlueCross BlueShield Location: Washington, DC Job Posted Time: 2026-09-16 11:49:29 About the job Experience: •3 years customer service, claims, inbound call center experience. Required Skills: •Answers complex member inquiries by clarifying desired information; researching, locating, and providing information. Resolves complex member service problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems. •Examines claims to identify key elements, and processing requirements based on diagnosis, procedures, provider, medical policy, contracts, and policy and procedures. Calculates deductibles, maximums, and determining resolving, reporting, and following through on overpayments, underpayments, and managed care processes. •Identifies clients who are eligible or in need of managed care interventions and collaborates with the clinical professionals in designing and implementing the intervention. •Assist with training of new hires. Qualifications: •The Rep, Member Service II is responsible for complex benefits, claims, and general inquiries. They have broader knowledge of the following: systems, benefits, contracts/products, functions of other departments in the company, standard operating procedures, claims status, enrollment/billing and follow-up to a customer inquiry. •High School Diploma or GED. •Knowledge, Skills And Abilities (KSAs) •Self-starter with strong organizational skills and planning skills. •Demonstrated capacity to maintain effective interpersonal relationships. •Demonstrated capacity to recognize, analyze, and solve a variety of problems. •Excellent communication skills both written and verbal. •Resolves customer concerns by obtaining information from customer service representative; calling customer back with new information. Compensation: •$38,520 - $70,620 / year •Competitive benefits and rewards package Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!