Member Guide

Minimum of 2 years of experience in health plans, benefits, claims management, or customer service. Ability to work weekend shifts. Strong fluency in health insurance terminology. Highly proficient with Google Workspace, CRM/ticketing systems, claims portals, Slack, IVR/telephony tools, and internal knowledge bases. Excellent communication skills, both written and verbal. Structured and meticulous problem-solver with strong attention to detail. Takes initiative and follows through. Experience using third-party administrators (TPAs) or in claims adjudication workflows is a plus. Experience using Looker or similar analytics tools is a plus. Prior exposure to early-stage or rapidly scaling healthcare organizations is a plus.

Serve as the first point of contact for member and provider inquiries. Educate members on their benefits. Capture, document, and triage claims inquiries. Research claim details and resolve disputes. Identify root causes of inquiries and recommend process improvements. Provide feedback to enhance internal systems and workflows. Deliver empathetic support and ensure complete resolution of issues. Collaborate cross-functionally to ensure seamless handling of issues.