Member Services Representative – Health Plan (Bilingual) – El Salvador

Looking for healthcare customer service jobs in El Salvador? Fusion CX is hiring Member Services Representatives to assist health plan members, family members, caregivers, and healthcare providers with questions about health insurance benefits and coverage. If you have strong B2-level English skills, enjoy helping people, and can explain information clearly and empathetically, this opportunity offers a chance to build your career in health insurance customer service, healthcare support, and member services.

Job Descriptions:

About the Role

As a Member Services Representative – Health Plan at Fusion CX, you will provide customer support by phone and email, helping members understand their health plan benefits, eligibility, referrals, and claims. You will take ownership of inquiries through resolution, coordinate with healthcare providers and internal departments when needed, and follow applicable regulatory requirements, including HIPAA, while maintaining accurate documentation.

Key Responsibilities

• Provide quality customer service by following established service principles and departmental guidelines.
• Explain health plan benefits and available plan options to members, family members, caregivers, and healthcare providers by phone or email.
• Respond to inquiries about benefits, eligibility, referrals, claims, and related issues, following departmental policies, procedures, and job aids.
• Follow up with members to clarify concerns, identify the cause of an issue, explain solutions, and take ownership through resolution.
• Resolve member questions and complaints accurately and efficiently, coordinating with healthcare providers and other departments when necessary.
• Escalate appropriate issues to management or the relevant department.
• Participate in member calling projects assigned by management to support membership retention.
• Complete member forms and document transactions, actions taken, and follow-up details in the appropriate system.
• Meet or exceed departmental standards for quality, productivity, schedule adherence, and attendance.
• Protect member information and follow applicable Federal, State, and HIPAA requirements.

Job Requirements:

• English Proficiency: B2 – Advanced, spoken and written.
• Age and Identification: Must be at least 18 years old and have a valid DUI.
• Education: Completed high school diploma.
• Experience: Minimum of 6 months of contact center experience, preferably in healthcare, health insurance, or member services.
• Computer Skills: Ability to navigate the web, work across multiple windows and systems simultaneously, use email, and work with Microsoft Office or Google tools.
• Typing and Written Communication: Functional typing skills and strong written English. The minimum words-per-minute requirement is to be confirmed with Operations.
• Schedule: Availability to work rotating shifts, including weekends and holidays as required.
• Training: Availability to complete initial training with 100% attendance.
• Health Plan Knowledge: Ability to learn and explain health plan benefits, eligibility, referrals, and claims while following applicable policies and privacy requirements.

Key Competencies

• Ownership and follow-through until member issues are resolved.
• Empathy and patience when assisting members, family members, and caregivers.
• Clear communication and accurate explanations of health plan information.
• Accurate documentation and compliance with policies and HIPAA requirements.
• Problem-solving and effective coordination with healthcare providers and internal teams.
• Continuous improvement mindset, including identifying workflow issues and suggesting efficiencies.

Preferred Qualifications

• Previous BPO experience supporting health plan, health insurance, or member services accounts.
• Familiarity with Medicare or U.S. health plan benefits, eligibility, referrals, and claims.
• Experience with member retention or outbound calling projects.

Why Join Fusion CX El Salvador?

Join Fusion CX and contribute to a member-focused healthcare support program where clear communication, empathy, and accurate information help people navigate their health plan services.

What You Will Gain

• Experience in health plan customer service and member support.
• Opportunities to strengthen communication, problem-solving, and issue-resolution skills.
• Exposure to health insurance terminology, member services, and healthcare privacy requirements.

Apply Today

Ready to explore health insurance jobs in El Salvador? Apply for the Member Services Representative – Health Plan position at Fusion CX and put your communication and customer service skills to work. If you’re searching for healthcare customer service jobs in El Salvador, health insurance support jobs, or member services representative jobs, and meet the B2 English and contact center experience requirements, we encourage you to apply.