Support Services Specialist

The Member and Provider Experience Specialist serves as the first point of contact for members and healthcare providers, delivering high-quality, compassionate, and solution-oriented support over the phone. This role is responsible for resolving benefit, eligibility, and claims-related inquiries while ensuring an exceptional service experience for all stakeholders.

Responsibilities

Answer inbound calls from members and providers in a professional and courteous manner; Provide accurate information regarding benefits, eligibility, claims status, authorizations, and network participation; Research and resolve complex inquiries by collaborating with internal departments; Educate members and providers on plan policies, digital tools, and available resources; Escalate issues as appropriate to ensure timely resolution; Maintain confidentiality and adhere to HIPAA guidelines; Meet or exceed performance metrics related to call quality, timeliness, and customer satisfaction; Play a critical role in evolving and strengthening the Support team as the company scales and takes on new challenges

Requirements

Empathy and active listening; A strong commitment to accuracy and attention to detail; The ability to prioritize workload effectively in a fast-paced environment; Strong communication skills; Problem-solving and critical thinking; Dependability and accountability; Team-oriented mindset

Nice to have

Experience with innovative health insurance plan designs, including Reference-Based Pricing (RBP), cash payment models, and employer-sponsored Direct Primary Care; Familiarity with HIPAA, CMS, or managed care guidelines; Bilingual skills (especially Spanish)

Benefits

Equity opportunities; Health benefits; 401K with Employer matching; Career growth and development opportunities; Remote capabilities