Senior Member Services Specialist

This is a fully remote position, open to applicants in Arizona, +25 more states.

📋 Description

• Manage intricate and sensitive member cases from start to finish, including appeals, denied claims and applications, coverage loss, COBRA, deductible disputes, and urgent care needs.

• Handle member calls related to specialty workflows, including challenging conversations.

• Determine the appropriate process for handling denials, appeals, denied applications, and denied claims.

• Review case history, pinpoint issues, and deliver clear resolutions.

• Keep members informed according to their timelines.

• Clearly and accurately communicate coverage, eligibility, and reimbursement guidelines.

• Facilitate cases involving Jira, Compliance, clinics, or benefits administrators until resolution.

• Escalate and transfer cases with adequate context.

• Manage general support inquiries across various programs and channels.

• Recognize recurring member challenges and suggest effective solutions.

• Work assigned shifts, including evenings, overnights, weekends, and holidays, as required.

⛳️ Requirements

• Valid work authorization in the US.

• Experience with claims, appeals, reimbursement, or payments (preferred).

• Familiarity with fertility benefits, specialty healthcare, or financial operations (preferred).

• Proficiency in using Zendesk, Jira, and Slack (preferred).

• Experience in mentoring colleagues or supporting QA initiatives (preferred).

• Fluency in Spanish, both written and verbal (preferred).

• Ability to work assigned shifts, including evenings, overnights, weekends, and holidays, as needed.

• Position available to candidates in AZ, DC, DE, FL, GA, HI, IL, KS, MA, MD, ME, MI, MN, MO, NC, NJ, NM, NV, NY, OH, OR, PA, SC, TN, TX, VA, VT, WI.

🏝️ Benefits

• Equity.

• Employer-covered health, dental, and insurance plan options.

• Access to Maven’s comprehensive platform and specialists, including mental health, reproductive health, family planning, and pediatrics.

• Wellness partnerships.

• Hybrid work environment, in-office meals, and collaborative workdays.

• 16 weeks of fully paid parental leave.

• New parent stipend for employees with over 1 year of service.

• Annual stipend for professional development.

• Personal career coaching provided through Maven for Mavens.

• 401(k) matching for US-based employees, with immediate vesting.