Customer Experience Specialist

Role Overview

• Build caring connections with every member by always leading with empathy, patience, and respect, ensuring members feel heard, supported, and valued throughout every interaction.
• Own each member interaction end-to-end, taking accountability to resolve inquiries during the initial contact and ensuring clear follow-through when additional steps are required.
• Deliver exceptional service by consistently exceeding member expectations and reinforcing a culture focused on trust, compassion, and first-call resolution.
• Accurately respond to member inquiries regarding benefits, eligibility, services, policies, and procedures in a clear, confident, and member-friendly manner.
• Assist members with provider network and claim/reimbursement inquiries, benefit questions related to transportation, food, dental and other support services and needs, proactively identifying solutions and next steps.
• Answer incoming contacts within established service levels while always managing complex and sensitive situations with professionalism and care.
• Thoroughly document all member interactions, actions taken, and outcomes in real time to ensure accuracy, continuity of care and effective resolution.
• Proactively address member complaints, grievances, and disenrollment concerns with goal to resolve by listening for root causes, offering solutions, and escalating appropriately when needed.
• Support outbound outreach initiatives and service programs designed to improve engagement, education, and overall member experience.

Requirements

• 2+ years of customer service, contact center, or member support experience, preferably in healthcare and/or Medicare Advantage.
• High school diploma or GED required.
• Minimum typing speed of 40 WPM.
• Proficient in navigating multiple systems simultaneously, including Microsoft Outlook, Word, Excel, CRM and Contact Center solutions.
• On camera presence for 100% Remote training, one on one, team and group meetings.
• Clear, concise and warm verbal communication skills with the ability to explain complex information simply and compassionately and ability to document interactions accurately.
• Demonstrated empathy, patience, and respect when working with older adults and individuals with disabilities.

Benefits

• Health insurance
• Professional development opportunities