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, provide solutions to escalated issues, and proactively identify potential problems to support exceptional member and client service. As part of the Account Management team, the specialist works cross-functionally with claims, customer service, analytics, and clinical teams. The role aims to deliver high-quality, cost-effective results for plan members and sponsors and to steward plan healthcare spending. This is an onsite position 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 or additional equivalent related work experience from an accredited university; Business, Communications, or medical insurance experience is preferred.
- Strong proficiency with Microsoft Office.
- Strong verbal and written communication skills, with the ability to tailor communications to the audience and business objectives.
- Ability to communicate and work effectively across operational areas and in cross-functional teams.
- Ability to maintain confidentiality and comply with 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 heavily emphasized.
- Self-starter with the ability to identify problems or issues and offer workable solutions.
- Ability to prioritize projects or seek guidance on prioritization.
- Confidence, high energy, enthusiasm, and a strong regard for client advocacy and service.
- Ability to travel to multiple work locations occasionally, such as for meetings, events, and conferences.
Nice To Haves
- One to three years of experience in the health insurance administration industry.
Responsibilities
- Design member solutions for clients, coordinate with internal operational departments, and assist clients’ Human Resources team members.
- Execute proactive strategies for resolving escalated member issues.
- Manage and troubleshoot client EDI eligibility files.
- Provide concierge support to members and serve as an immediate escalation resource for customer service representatives and claims examiners.
- Research claims where applicable.
- Proactively contact members as determined by the escalation, Account Executive, and client HR Benefits leadership.
- Resolve escalated member issues routed through member calls or HR Benefits leadership.
- Triage and escalate member issues to the appropriate department when necessary.
- Follow up with members to ensure prior 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 reports 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
