Customer Care Specialist

Position Purpose

The Customer Care Specialist is responsible for providing high-quality, empathetic, and accurate support to members by responding to inquiries regarding benefits, eligibility, and general healthcare services. This role serves as a primary point of contact for member communications, handling both written and telephone interactions to ensure timely and effective resolution of questions and concerns. The position plays a key role in enhancing the members’ experience by building positive relationships, advocating for member needs, and supporting access to healthcare services. Through responsive and solution-focused communication, the Customer Care Specialist contributes to the organization’s commitment to delivering accessible, compassionate, and member-centered care.

Essential Job Responsibilities

• Serve as the primary point of contact for members via phone, email, written correspondence, and occasional in-person interactions, providing accurate information on benefits, eligibility, care coordination, and health plan navigation.
• Conduct proactive outreach to new and returning members to welcome them, explain available services, promote preventive care, and encourage engagement in health management and follow-up care.
• Listen to member concerns, research issues using multiple systems, and provide clear, empathetic, and accurate resolutions to support member understanding and trust.
• Collaborate with internal departments such as Care Coordination, Provider Relations, Behavioral Health, Utilization Management, and Claims to resolve member needs efficiently and in accordance with organizational policies and regulations.
• Document all member interactions accurately and timely in call tracking and case management systems to ensure compliance and continuity of care.
• Maintain strict confidentiality and comply with HIPAA and all privacy and security requirements.
• Educate members on health plan benefits, including provider access, prior authorization processes, pharmacy benefits, wellness programs, and available services.
• Connect members to community resources and social support services such as housing, food assistance, transportation, and behavioral health supports.
• Identify trends, recurring issues, and service gaps and provide recommendations for process improvement and enhanced member experience.
• Working with a variety of personalities, maintaining a consistent and fair communication style.

Minimum Qualifications

• High school diploma or equivalent required.
• Valid driver’s license and proof of current automobile insurance required.
• Valid eligibility to participate in federal healthcare programs (no suspension, exclusion, or debarment from Medicare/Medicaid or similar programs).
• Minimum of two (2) years of customer service experience, preferably in healthcare, insurance, or public service environments.
• Experience working in healthcare, insurance, or public service settings.
• Strong communication skills, including active listening, clear verbal communication, and professional written communication.
• Ability to de-escalate challenging situations with empathy, patience, and professionalism.
• Proficiency using multiple systems simultaneously, including call center or case management platforms and Microsoft Office Suite (Outlook, Word, Excel).
• Experience working on diverse teams and adapting to different communication styles.
• Experience supporting or serving diverse communities, including communities of color.
• Collaborative, team-oriented mindset with a proactive approach to problem-solving and continuous service improvement.
• Commitment to serving diverse, underserved, rural, and vulnerable populations with cultural sensitivity and equitable service delivery.
• Strong professionalism, reliability, adherence to confidentiality, compliance, and accountability standards in a healthcare environment.
• Some college coursework or certifications in healthcare, human services, customer service, or medical administration.

Benefits

• Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
• Medical, dental, and vision insurance
• 401(k) with company match (fully vested immediately)
• Company-sponsored life insurance and additional benefits
• Fitness reimbursement program
• Tuition reimbursement and more

Inclusive Culture

We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.

Growth & Development

We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.

Work/Life Balance

We promote flexibility and well-being so employees can thrive both professionally and personally.