Member Service Support Specialist

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

📋 Description

• Respond to incoming calls from members and providers concerning health plan benefits, claims, eligibility, and general inquiries.

• Investigate, find, and deliver accurate information while ensuring a positive customer experience.

• Address member service issues by identifying concerns, researching solutions, implementing suitable resolutions, and escalating complex issues when necessary.

• Review and assess claims based on diagnosis codes, procedures, provider information, medical policies, contracts, and established policies and procedures.

• Provide education to members and providers regarding benefits, coverage, and health plan processes.

• Identify members who could benefit from care management or managed care interventions and work with clinical staff to facilitate appropriate services.

• Accurately and thoroughly document all interactions in compliance with company policies and regulatory requirements.

• Ensure adherence to HIPAA and relevant healthcare regulations.

• Achieve productivity, quality, attendance, and customer satisfaction standards.

⛳️ Requirements

• A High School Diploma or GED is required.

• Proficient computer and data entry skills.

• Exceptional verbal and written communication abilities.

• Strong problem-solving and critical thinking skills.

• Capability to multitask and navigate multiple systems concurrently.

• Keen attention to detail and a commitment to accuracy.

• Ability to work independently as well as collaboratively within a team.

• Professional demeanor with a strong emphasis on customer satisfaction.

• Previous experience in a call center or customer service setting is preferred.

• Familiarity with Medicare and Medicaid programs is preferred.

• At least one (1) year of experience in customer service or a call center environment is preferred.

• Experience in healthcare, insurance, Medicare, or Medicaid is preferred.

• Understanding of health plan systems, products, policies, procedures, and departmental functions.

• Ability to maintain compliance with HIPAA and healthcare regulations.

🏝️ Benefits

• Opportunities for career advancement from within the organization.

• A rewarding work environment.

• Opportunities available across multiple locations in the US, South America, and India.