Member & Provider Care Specialist

This is a Fully Remote Job About Our Client:The organization operates within the health insurance industry, addressing the challenge of providing member-centered insurance services. Founded in 2012, it utilizes a full-stack technology platform to deliver health insurance solutions designed to closely support members in a manner comparable to personalized care. About the Opportunity:The MEMBER & PROVIDER CARE SPECIALIST role focuses on resolving complex issues affecting providers and the members they serve. This position acts as a subject matter expert and liaison between operational and strategic teams, overseeing case management, internal support, and communication processes. The role contributes to improving member and provider experiences through effective issue resolution and knowledge management. Responsibilities:Handle inbound and outbound communications with members and providersManage caseload and queue through dashboard toolsIdentify, investigate, and resolve issues within service level agreementsCollaborate with colleagues and leadership to identify trends and obstaclesUtilize internal systems and resources efficientlyCommunicate findings and solutions with providers and departmentsSupport representatives with complex issues, workflows, and trainingUpdate and escalate information in the internal knowledge management systemPartner with production teams to enhance member and provider servicesComply with applicable laws and regulationsPerform other duties as assigned Requirements:Minimum 1 year in customer support, healthcare, technology, or related fieldExperience in fast-paced environmentsAt least 6 months in member and customer serviceMinimum 1 year of escalations experience in customer service Bonus Points:1+ year of claims experienceBilingual Spanish proficiency Pay Range and Compensation Package:The set rate for this role is 22.00 per hourEligibility for employee benefits and monthly vacation accrual at a rate of 15 days per year Benefits & Perks:Medical insuranceVision insuranceDental insurance401(k) plan participationPaid parental leave Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.