Member & Provider Care Specialist

This is a Fully Remote Job About Our Client: The organization operates within the health insurance industry, addressing the challenge of providing member-centered insurance services. Founded in 2012, it utilizes a full-stack technology platform to deliver health insurance solutions designed to closely support members in a manner comparable to personalized care. About the Opportunity: The MEMBER & PROVIDER CARE SPECIALIST role focuses on resolving complex issues affecting providers and the members they serve. This position acts as a subject matter expert and liaison between operational and strategic teams, overseeing case management, internal support, and communication processes. The role contributes to improving member and provider experiences through effective issue resolution and knowledge management. Responsibilities: Handle inbound and outbound communications with members and providers Manage caseload and queue through dashboard tools Identify, investigate, and resolve issues within service level agreements Collaborate with colleagues and leadership to identify trends and obstacles Utilize internal systems and resources efficiently Communicate findings and solutions with providers and departments Support representatives with complex issues, workflows, and training Update and escalate information in the internal knowledge management system Partner with production teams to enhance member and provider services Comply with applicable laws and regulations Perform other duties as assigned Requirements: Minimum 1 year in customer support, healthcare, technology, or related field Experience in fast-paced environments At least 6 months in member and customer service Minimum 1 year of escalations experience in customer service Bonus Points: 1+ year of claims experience Bilingual Spanish proficiency Pay Range and Compensation Package: The set rate for this role is 22.00 per hour Eligibility for employee benefits and monthly vacation accrual at a rate of 15 days per year Benefits & Perks: Medical insurance Vision insurance Dental insurance 401(k) plan participation Paid parental leave Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note: TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.