Member Care Specialist

Skill Requirements

• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel
• Strong written and verbal communication skills
• Excellent attention to detail and solid problem-solving abilities
• Ability to remain calm, professional, and customer-focused while handling calls

Qualifications

• High school diploma or GED
• 1–2 years of experience in a provider office, healthcare setting, and/or fast-paced call center environment
• At least 1 year of direct experience in healthcare, health insurance, or a related field, with a strong understanding of medical terminology and/or provider office operations
• Bilingual in Spanish and English preferred

What You'll Love About This Role

• Serving members and healthcare providers with questions and service needs
• Solving complex issues with empathy, resourcefulness, and care
• Educating members and providers on benefits, tools, and navigation of our site and applications
• Being part of a team that is improving the healthcare experience in a meaningful way

What You’ll Be Doing

• Answering incoming calls from members and providers regarding benefits, eligibility, and claims
• Researching and resolving complex issues using internal tools, documentation, and outbound outreach
• Educating members and providers on platform navigation, benefits, and available resources
• Accurately documenting each interaction and following established procedures
• De-escalating concerns and handling first-level complaints with professionalism and empathy
• Supporting appeals processes and ensuring timely follow-up actions are completed