Member and Provider Experience Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Respond to inbound calls from members and providers in a professional and courteous manner.

• Deliver precise information regarding benefits, eligibility, claims status, authorizations, and network participation.

• Investigate and resolve complex inquiries by collaborating with internal departments.

• Inform members and providers about plan policies, digital tools, and available resources.

• Escalate issues as necessary to ensure timely resolution.

• Uphold confidentiality and comply with HIPAA regulations.

• Achieve or surpass performance metrics related to call quality, timeliness, and customer satisfaction.

• Contribute significantly to the development and enhancement of our Support team as we grow and face new challenges.

⛳️ Requirements

• Experience with innovative health insurance plan designs, such as Reference-Based Pricing (RBP), cash payment models, and employer-sponsored Direct Primary Care.

• Knowledge of HIPAA, CMS, or managed care guidelines.

• Bilingual abilities (particularly in Spanish) are an advantage.

🏝️ Benefits

• Equity opportunities.

• Competitive Salary.

• Health benefits.

• 401K with Employer matching.

• Career growth and development opportunities.

• Remote capabilities.

• Work Hours will be Monday - Friday 9am - 6pm EST.

• High-trust team with radically high transparency and autonomy.