Member Specialist Services

Job Summary

Must have excellent understanding of benefits, products and other health care and/or insurance issues as they pertain to customers (internal/external). This position is to provide service and support to managed care customers through verbal or written communication. This position acts as the primary liaison both telephonic and in-person between all members and the plan.

The Member Services Specialist serves as a frontline ambassador for the health plan, delivering high-quality, resolution-focused support to members, providers, and brokers across multiple lines of business.

As the initial point of contact, this role extends beyond basic call handling. Specialists are trained to navigate the foundational pillars of our healthcare offerings, including the Health Exchange, US Family Health Plan, and NCHD, with a strong emphasis on first-call resolution.

Specialists develop working knowledge of benefit structures, assist callers wi...