Member Support Specialist | Employee Benefits

The Member Support Specialist is responsible for delivering high-quality service to members by addressing questions related to benefits, eligibility and medical claims. This role serves as a primary point of contact for member inquiries, working closely with providers, carriers and internal team members to resolve issues efficiently and accurately. The ideal candidate demonstrates strong communication skills, attention to detail and the ability to problem-solve in a fast-paced environment.

Work Performed:

• Handle inbound customer service calls regarding employer-sponsored benefit plans
• Review and investigate medical claims, coordinating with providers and carriers to ensure accurate processing and resolution of discrepancies
• Communicate benefit eligibility and explain plan provisions based on plan documents
• Assist members in understanding benefit options and navigating their coverage
• Conduct outreach to providers, clients and carriers as needed to support issue resolution
• Document and maintain accurate call notes and activity in the tracking system
• Utilize internal systems and databases to provide timely and accurate information
• Manage time effectively while maintaining attention to detail and service quality
• Handle challenging member interactions with professionalism and escalate issues when appropriate
• Collaborate with team members to resolve complex issues and support departmental needs
• Support enrollment activities, including handling enrollment calls and assisting during peak periods such as Open Enrollment
• Participate in additional projects and tasks within the Benefits department as needed
• Build and maintain positive, professional relationships with members, coworkers and external partners

• Life & Health Insurance License
• Strong communication skills with a customer-first mindset and professional phone etiquette
• Ability to troubleshoot issues with empathy, patience and critical thinking
• Detail oriented with strong organizational and time management skills
• Comfortable working in a fast-paced, team-oriented environment
• Basic technical aptitude and ability to navigate multiple systems and databases

Preferred Education & Experience

• Prior experience in customer service, benefits administration or healthcare-related support
• Bilingual in Spanish (preferred, but not required)