Member Experience Specialist
About The Position
The Member Experience Specialist (MES) works with the Account Executive to improve the member experience for assigned clients. The role engages members and HR Benefits leaders to identify needs, resolve escalated issues, and proactively spot potential service problems. It is part of the Account Management team and works cross-functionally with claims, customer service, analytics, and clinical teams. The goal is to deliver high-quality, cost-effective outcomes for plan members and sponsors while stewarding healthcare spending. This is an onsite role at 2929 Walker Ave NW, Walker, MI 49544, with work hours Monday through Friday, 8 a.m. to 5 p.m.
Requirements
- At least 1 year of related work experience.
- A related bachelor’s degree from an accredited university, or additional related equivalent work experience.
- Strong proficiency with Microsoft Office.
- Strong verbal and written communication skills, including the ability to tailor communications to the audience and business objectives.
- Ability to communicate at high levels across operational areas and work in cross-functional teams.
- Maintain confidentiality and observe HIPAA requirements.
- Strong customer service skills.
- Ability to work independently and proactively, as well as collaboratively as a team member.
- Ability to thrive in a team environment where team success is emphasized.
- Self-starter with the ability to identify problems or issues and offer workable solutions.
- Ability to prioritize projects or seek guidance on prioritization.
- Ability to project confidence, high energy, enthusiasm, and strong regard for client advocacy and service.
Nice To Haves
- A degree preferably in Business or Communications, or experience working in the medical insurance field.
- One to three years of experience in the health insurance administration industry.
Responsibilities
- Design member solutions for clients, work directly with internal operational departments, and assist clients’ Human Resources team members.
- Execute proactive strategies for resolving escalated member issues.
- Manage eligibility responsibilities and troubleshoot client EDI files.
- Serve as concierge support and the immediate escalation resource for customer service representatives and claims examiners.
- Research claims where applicable.
- Conduct proactive outbound outreach to members as determined by the escalation and Account Executive, and as directed by client HR Benefits leadership.
- Resolve member issues escalated through member calls or HR Benefits leadership.
- Triage and escalate member issues to the appropriate department when necessary.
- Follow up with members to ensure previous issues are resolved in a timely manner.
- Support members and providers with out-of-network facility services and provider billing challenges.
- Use systems to track complaints and resolutions.
- Prepare basic reporting and analytics demonstrating client service-level performance.
Benefits
- Medical, dental, vision, life, and global travel health insurance.
- Short- and long-term disability programs.
- Leave programs to support personal circumstances.
- 401(k) with employer contribution match.
- Paid time off, volunteer time off, and 11 holidays.
- Additional voluntary benefits options.
- Comprehensive wellness program.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
