Customer Care Specialist
About The Position
The Customer Care Specialist is responsible for providing high-quality, empathetic, and accurate support to members by responding to inquiries regarding benefits, eligibility, and general healthcare services. This role serves as a primary point of contact for member communications, handling both written and telephone interactions to ensure timely and effective resolution of questions and concerns. The position plays a key role in enhancing the members’ experience by building positive relationships, advocating for member needs, and supporting access to healthcare services. Through responsive and solution-focused communication, the Customer Care Specialist contributes to the organization’s commitment to delivering accessible, compassionate, and member-centered care.
Requirements
- High school diploma or equivalent required.
- Valid driver’s license and proof of current automobile insurance required.
- Valid eligibility to participate in federal healthcare programs (no suspension, exclusion, or debarment from Medicare/Medicaid or similar programs).
- Minimum of two (2) years of customer service experience, preferably in healthcare, insurance, or public service environments.
- Experience working in healthcare, insurance, or public service settings.
- Strong communication skills, including active listening, clear verbal communication, and professional written communication.
- Ability to de-escalate challenging situations with empathy, patience, and professionalism.
- Proficiency using multiple systems simultaneously, including call center or case management platforms and Microsoft Office Suite (Outlook, Word, Excel).
- Experience working on diverse teams and adapting to different communication styles.
- Experience supporting or serving diverse communities, including communities of color.
- Collaborative, team-oriented mindset with a proactive approach to problem-solving and continuous service improvement.
- Commitment to serving diverse, underserved, rural, and vulnerable populations with cultural sensitivity and equitable service delivery.
- Strong professionalism, reliability, adherence to confidentiality, compliance, and accountability standards in a healthcare environment.
Nice To Haves
- Some college coursework or certifications in healthcare, human services, customer service, or medical administration.
- Bilingual or translation capabilities are a plus.
Responsibilities
- Serve as the primary point of contact for members via phone, email, written correspondence, and occasional in-person interactions, providing accurate information on benefits, eligibility, care coordination, and health plan navigation.
- Conduct proactive outreach to new and returning members to welcome them, explain available services, promote preventive care, and encourage engagement in health management and follow-up care.
- Listen to member concerns, research issues using multiple systems, and provide clear, empathetic, and accurate resolutions to support member understanding and trust.
- Collaborate with internal departments such as Care Coordination, Provider Relations, Behavioral Health, Utilization Management, and Claims to resolve member needs efficiently and in accordance with organizational policies and regulations.
- Document all member interactions accurately and timely in call tracking and case management systems to ensure compliance and continuity of care.
- Maintain strict confidentiality and comply with HIPAA and all privacy and security requirements.
- Educate members on health plan benefits, including provider access, prior authorization processes, pharmacy benefits, wellness programs, and available services.
- Connect members to community resources and social support services such as housing, food assistance, transportation, and behavioral health supports.
- Identify trends, recurring issues, and service gaps and provide recommendations for process improvement and enhanced member experience.
Benefits
- Salary is dependent on skills, experience, and education
- Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
- Medical, dental, and vision insurance
- 401(k) with company match (fully vested immediately)
- Company-sponsored life insurance and additional benefits
- Fitness reimbursement program
- Tuition reimbursement and more
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
