Member Care Specialist
Job Summary
The Care Specialist resolves complex issues impacting members and providers while serving as a subject matter expert for service operations. This role acts as a liaison between production and strategy teams, ensuring workflows and knowledge management systems are maintained. You will manage a queue of assigned cases and support internal teams to optimize the overall service experience.
Responsibilities
- Handle inbound/outbound member and provider communications
- Manage and resolve complex cases via dashboard
- Maintain internal knowledge management systems
- Support service representatives with training and workflows
- Partner with cross-functional teams to improve experience
Required Skills
- 1+ years customer support or healthcare experience
- 6+ months member service experience
- 1+ year escalations handling
- Ability to work in fast-paced environments
- Proficiency with internal CRM tools
Job Details
Responsibilities:
- Handle inbound and outbound calls, secure messages and/or email communications with members or providers.
- Manage queue work and assigned caseload through efficient dashboard management.
- Identify, investigate, and resolve issues within determined SLAs.
- Collaborate with colleagues, Experts, and Leads to identify trends and roadblocks.
- Utilize internal tools and resources seamlessly.
- Effectively communicate findings and resolutions with providers and internal departments.
- Support Member and Provider Services Representatives with complex issues, workflows, and training.
- Escalate updates or incorrect information in the internal knowledge management system.
- Partner with production teams across the LifeCycles to improve the member and provider experience.
- Ensure compliance with all applicable laws and regulations.
Qualifications:
- 1+ years in customer support, healthcare, tech and/or related field.
- Experience in a fast-paced environment.
- 6+ months of member and customer service experience.
- 1+ year of escalations experience in a customer service environment.
- High school diploma or GED.
Bonus Points:
- 1+ years of claims experience.
- Bilingual Spanish.
- Bachelor's degree.