Remote Full‑Time Member Service Representative – Customer Care Specialist for WellSense Health Plan (Work‑From‑Home)

Welcome to WellSense Health Plan – A Leader in Member‑Focused Healthcare

Founded in 1997, WellSense Health Plan is a nonprofit health insurance organization dedicated to serving more than 740,000 members across Massachusetts, New Hampshire, and a growing portfolio of states nationwide. Our mission is simple yet powerful: to deliver high‑quality, affordable health coverage that adapts to the diverse needs of every member, whether they are navigating Medicare, Medicaid, or individual and family plans. Over the past 25 years, we have earned a reputation for innovation, compassion, and relentless member advocacy. As we expand our footprint, we are looking for talented, service‑driven professionals who share our commitment to improving health outcomes and creating a more inclusive, respectful, and supportive healthcare experience.

At WellSense, you will join a vibrant community of problem‑solvers, innovators, and caring individuals who work together to make a tangible difference in the lives of hundreds of thousands of members every day. Our culture is built on transparency, continuous learning, and celebrating success—both big and small. Whether you are just starting your career or seeking a new challenge, WellSense offers a dynamic environment where your voice matters and your growth is championed.

Why Choose a Remote Career with WellSense?

Transitioning to a remote work model has never been more rewarding. As a Remote Member Service Representative, you will enjoy the flexibility of working from the comfort of your home while contributing to a mission‑driven organization that values your well‑being. Our remote team is supported by industry‑leading technology, comprehensive training, and a collaborative network of mentors and peers—all designed to set you up for success.

• Full‑time remote employment with a consistent Monday‑through‑Friday schedule (first shift, 8 AM – 6 PM EST, with variations to fit business needs).
• Competitive hourly wage of $19.50, plus performance‑based bonuses and annual cash retention incentives.
• Paid 10‑week onboarding program that equips you with deep knowledge of health‑insurance products, compliance standards, and effective communication techniques.
• State‑specific eligibility – positions are limited to residents of Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin.
• Comprehensive benefits package including a no‑premium health‑insurance option, paid time off, retirement savings plans, and employee assistance resources.
• Professional development resources such as the Ulysses Learning platform, one‑on‑one mentoring, a buddy‑system for new hires, and a clear pathway for internal career advancement.
• Diversity, equity, and inclusion (DEI) initiatives that foster an environment where every employee feels respected, valued, and empowered to bring their authentic self to work.

Position Overview – Remote Member Service Representative

The Member Service Representative serves as the front‑line ambassador for WellSense Health Plan, delivering accurate, courteous, and timely assistance to members, providers, and internal stakeholders. You will be responsible for interpreting plan details, solving complex inquiries, and creating positive experiences that reinforce member loyalty and trust. This role is an ideal entry point for individuals aspiring to build a long‑term career in health‑insurance customer service, with clear opportunities for promotion into supervisory, training, or specialized operational positions.

Core Responsibilities

• Answer a high volume of inbound calls from members and healthcare providers, managing interactions that range from quick five‑minute queries to in‑depth 45‑minute conversations.
• Utilize WellSense’s resource libraries, policy manuals, and digital tools to accurately interpret plan benefits, coverage details, and contractual obligations.
• Document each call in accordance with departmental standards, ensuring that all information is captured for compliance, analytics, and future reference.
• Employ strong interpersonal and de‑escalation skills to address challenging situations, turning potential frustrations into positive outcomes.
• Collaborate with teammates and cross‑functional departments to resolve complex issues, share best practices, and support a culture of continuous improvement.
• Consistently meet or exceed quality, productivity, and customer‑satisfaction targets set by the department.
• Participate actively in ongoing training sessions, coaching calls, and performance reviews to refine communication techniques and product knowledge.
• Contribute ideas for process enhancements, knowledge‑base updates, and service‑delivery innovations that improve the member experience.

Essential Qualifications

• Education: High school diploma or equivalent is required; a bachelor’s degree is preferred but not mandatory.
• Experience: Prior professional experience in a customer‑service‑oriented role is desirable. Experience in a call center environment is a plus, though we provide comprehensive training for those new to the industry.
• Communication Skills: Exceptional verbal and written communication abilities, with a clear, empathetic, and professional tone.
• Technical Proficiency: Comfortable using Microsoft Office Suite (Word, Excel, Outlook) and willing to quickly learn proprietary software platforms.
• Reliability: Consistent attendance record and ability to work overtime during peak periods when needed.
• Remote‑Work Setup: Dedicated, quiet workspace at home with a reliable high‑speed internet connection, headset, and computer that meet company specifications.

Preferred Qualifications & Desirable Skills

• Fluency in Spanish, Portuguese, Haitian Creole, or another language to serve our multilingual member base.
• Previous experience navigating health‑insurance terminology, Medicare, Medicaid, or related benefit programs.
• Demonstrated ability to multitask, prioritize high‑volume requests, and manage time efficiently under pressure.
• Strong problem‑solving aptitude with a track record of making sound business decisions based on policies and guidelines.
• Proven track record of achieving performance metrics such as average handle time, first‑call resolution, and customer satisfaction scores.

Core Competencies & Attributes for Success

• Customer‑Centric Mindset: A genuine desire to help people and improve their health‑care experience.
• Active Listening: Ability to fully understand member concerns before responding with precise, helpful information.
• Emotional Intelligence: Recognizing and appropriately responding to the emotions and needs of callers.
• Attention to Detail: Accurate documentation and strict adherence to compliance standards.
• Team Collaboration: Willingness to share knowledge, support colleagues, and contribute to a positive team dynamic.
• Adaptability: Comfort with evolving policies, new technologies, and fluctuating call volumes.
• Self‑Motivation: Proactive approach to learning, seeking feedback, and continuously improving performance.

Career Path & Growth Opportunities

WellSense is committed to nurturing internal talent. As a Member Service Representative, you will have clear pathways to advance into roles such as Senior Representative, Team Lead, Quality Assurance Analyst, Training Specialist, or Operations Manager. Our internal employee application program encourages lateral moves into departments like Claims, Provider Relations, or Sales, allowing you to broaden your skill set while staying within a supportive, values‑driven organization. Employees who demonstrate strong performance and a willingness to learn are regularly considered for promotions, salary increases, and leadership development initiatives.

Compensation, Benefits, and Perks

In addition to a base hourly wage of $19.50, eligible employees may earn performance‑based bonuses and an annual cash retention bonus for sustained service excellence. Our benefits suite includes:

• Medical, dental, and vision coverage, with a no‑premium health‑insurance option for eligible employees.
• Paid time off (vacation, sick leave, and holidays) that accrues with tenure.
• Retirement savings plans with company matching contributions.
• Employee Assistance Program (EAP) offering counseling, financial wellness resources, and work‑life balance support.
• Learning & development opportunities through Ulysses Learning, webinars, and certifications.
• Recognition programs that celebrate high achievers, innovative ideas, and teamwork.
• Access to employee resource groups (ERGs) focused on cultural diversity, LGBTQ+ inclusion, veteran affairs, and more.

Our Commitment to Diversity, Inclusion, and Employee Well‑Being

WellSense operates with a deep sense of responsibility toward fostering an inclusive workplace where all voices are heard. We conduct hiring practices without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, or protected veteran status. Our participation in the E‑Verify program ensures compliance with employment eligibility requirements. By cultivating Employee Resource Groups, offering flexible work arrangements, and providing regular DEI training, we strive to create a culture where every employee feels valued, respected, and empowered to contribute their best work.

How to Apply – Take the First Step Toward a Rewarding Remote Career

If you are enthusiastic, detail‑oriented, and eager to make a real difference in the lives of health‑care members, we want to hear from you. Click the “Apply Now” button below, complete the brief application, and a member of our talent acquisition team will be in touch shortly. Join WellSense Health Plan today and embark on a fulfilling journey where your talent, compassion, and dedication are celebrated every day.

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