Member Benefits Specialist - Member Services Professional - MST Time Zone

Position Location: 100% remote. Candidates must be comfortable with MST shifts.

Responsibilities

• Deliver above-and-beyond service over multiple channels including phone, email, and portal inquiries by acting as a single point of contact and maintaining ownership of member resolution.
• Become an expert in benefit administration, Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Level Funded plans, minimal essential coverage plans, and alternative benefit payment designs (e.g., reference-based pricing).
• Guide members in understanding health benefit coverage, including accumulators, explanation of benefits, out-of-pocket maximums, reimbursement levels, and federal regulations such as NSA and ACA.
• Take ownership of the member experience from beginning to end, reducing handoffs to ensure consistency and resolution.
• Anticipate member needs and conduct research on their behalf to resolve issues.
• Educate members on pre- and post-services in conjunction with benefits to optimize their healthcare journey.
• Collaborate with internal and external partners to ensure best-in-class service delivery.
• Resolve member complaints.
• Adhere to HIPAA guidelines and Privacy Rules for all calls and correspondence.
• Complete provider research, appointment scheduling, medical record retrieval, and other non-clinical duties within applicable timeframes and in compliance with Policy & Procedures.
• Ensure accurate documentation in appropriate software.

Requirements

• High school diploma or GED.
• 1+ year of healthcare industry work experience.
• Experience delivering client-focused solutions based on customer needs in direct member contact and education (virtual/telephonic or in-person).
• 1+ year of telephonic verification of medical benefits preferred.
• 2+ years of healthcare experience (e.g., carrier, TPA, patient advocate, or other benefits-focused role) preferred.
• Medical claims exposure (ICD-9/10 coding, CPT coding, and medical claim forms) preferred.

Skills

• Proficient in Microsoft Outlook, Word, and Excel.
• Service-driven mindset.
• Aptitude for learning and retention.
• Advanced soft skills with a high level of emotional intelligence.
• Strong written communication skills.

Benefits

• Multiple health plan options.
• Company-paid employee premiums for disability and life insurance.
• Parental Leave Policy.
• 20 days PTO to start / 10 paid holidays.
• Tuition reimbursement.
• 401k company contribution.
• Company-paid short- and long-term disability plus life insurance.
• Professional development initiatives and continuous learning opportunities.
• Opportunities to participate in and support the company’s diversity and inclusion initiatives.