Member & Provider Care Specialist
Core
Resolve complex issues and concerns for members and providers, acting as a liaison between production and strategy teams.
Role type
Senior IC Member & Provider Care Specialist
Builds
Member and provider experience through issue resolution and workflow optimization
Domain
Health Insurance / Customer Support
Deliverable
client delivery
Required skills
Escalation management, SLA adherence, queue management, internal tool utilization, knowledge management, cross-functional collaboration, complex issue resolution
Preferred skills
Claims experience, Bilingual Spanish
Technologies
Internal dashboards, knowledge management systems
Responsibilities
Handle inbound/outbound communications with members and providers; Manage assigned caseloads via dashboard; Identify and resolve issues within SLAs; Collaborate with colleagues to identify trends; Support representatives with complex issues and training; Update internal knowledge management systems; Partner with production teams to improve experience.
Seniority
Mid-level, hands-on IC