Member Services Representative – Health Plan (Bilingual)

About the role

Fusion CX is hiring Member Services Representatives in El Salvador to support health plan members, family members, caregivers and healthcare providers with questions about health insurance benefits and coverage. The role provides customer support by phone and email, explains benefits, eligibility, referrals and claims, and follows regulatory requirements such as HIPAA while keeping accurate records.

Key responsibilities

• Provide quality customer service following service principles and departmental guidelines.
• Explain health plan benefits and plan options by phone or email.
• Respond to inquiries about benefits, eligibility, referrals and claims, and follow up with members until issues are resolved.
• Resolve questions and complaints accurately and efficiently, escalating complex issues to management or the relevant department.
• Take part in member calling projects assigned by management to support membership retention.
• Complete member forms and document transactions and follow-up details in the system.
• Meet departmental standards for quality, productivity, schedule adherence and attendance.
• Protect member information and comply with Federal, State and HIPAA requirements.

Required profile

• B2-level English, spoken and written.
• At least 18 years old and a valid ID.
• High school diploma completed.
• Minimum 6 months of contact center experience, preferably in healthcare, health insurance or member services.
• Availability for rotating shifts, including weekends and holidays, and for full initial training.
• Ability to learn and explain health plan benefits, eligibility, referrals and claims.

Required skills

• Navigate the web, work across multiple windows and systems, use email and Microsoft Office or Google tools.
• Functional typing and strong written English.
• Preferred: previous BPO experience in health plan or member services, familiarity with Medicare or U.S. health plans, and experience with member retention or outbound calling.