Member Services Specialist
Core
Resolve complex and sensitive member cases involving denied claims, appeals, coverage disputes, and urgent care needs via phone and writing.
Role type
Senior Member Services Specialist (Healthcare Member Support)
Builds
End-to-end resolution of member issues for a virtual women's and family health platform
Domain
Healthcare / Member Services / Insurance Claims
Deliverable
client delivery
Required skills
Case investigation, claims and appeals processing, reimbursement rules explanation, multi-channel communication, stakeholder coordination, workflow triage
Preferred skills
Fertility benefits knowledge, financial operations experience, Zendesk/Jira/Slack proficiency, Spanish fluency
Technologies
Zendesk, Jira, Slack
Responsibilities
Own complex cases from first contact to resolution including denied claims and appeals; Handle sensitive conversations on specialty workflows; Investigate member issues by reviewing history and identifying root causes; Drive cases requiring external parties (clinics, benefits admins) to completion; Balance complex escalations with general support volume; Identify recurring member issues and propose solutions
Seniority
Mid-level, hands-on IC