Service Resolution Specialist

Point C

2d•$45,000 - $50,000•Onsite

About The Position

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company. Point C is seeking a Service Resolution Specialist (SRS) to join our Customer Service team, supporting the Rapid Response Team and reporting to the Customer Service Director. The SRS is the first dedicated level of service resolution within Customer Service, handling second-level escalations that front-line Customer Service Representatives cannot resolve. The SRS investigates and resolves routine and standard client and member issues quickly and accurately and escalates more technically complex matters to an Employer Service Representative. Over time, the SRS is intended to serve as the direct initial point of contact for clients on standard items.

Requirements

High school diploma or GED required
2+ years of experience in health benefits customer service, claims, or member services
Working knowledge of claims processing, eligibility, and benefit structures
Proficiency with CRM/ticketing systems (e.g., Zendesk) and standard office software
Strong written and verbal communication skills with a customer-service orientation

Nice To Haves

associate or bachelor's degree preferred
Experience in a third-party administrator (TPA), health plan, or PBM environment is a plus
Familiarity with medical coding and billing fundamentals is a plus
Prior escalation, second-level, or issue-resolution support experience is a plus

Responsibilities

Resolve second-level escalations beyond first-line CSR capability across claims, eligibility, benefits, and billing inquiries
Investigate issues thoroughly, document findings, and record all activity in the centralized escalation tracker
Determine root cause where possible; when the issue is an education matter, work directly with the member to provide education
Assist in escalated call audits and tracking currently being done by the Customer Service Director
Escalate to an ESR when an issue is technically complex or requires deeper expertise, providing a clear and documented handoff
Take approved immediate actions within authority and route “send-on” items to the appropriate team
Meet acknowledgment, response, and resolution SLAs based on issue severity
Coordinate all client-facing responses through Account Management and the RRT; avoid conflicting or untracked communication
Flag recurring issues and emerging patterns to the RRT to support trend identification and root cause analysis