Claims Customer Experience Specialist

FedPoint; Portsmouth (NH); Hybrid; USD 34,440 - 41,328; Part time

Job summary

A benefits services company is seeking a Claims Customer Experience Specialist in Portsmouth, NH. This part-time role involves resolving customer complaints, analyzing customer satisfaction data, and collaborating across departments to improve service delivery. The ideal candidate will have at least 3 years of relevant experience and possess strong analytical and communication skills. This position offers a hybrid work schedule of 24 hours a week, primarily during the day.

Qualifications

• Minimum 3 years of FLTCIP experience or 3+ years in insurance or LTC operations.
• Strong knowledge of FLTCIP product requirements and claims processes.
• Experience investigating complex complaints and working within multistage complaint frameworks.

Responsibilities

• Communicate directly with customers regarding complaints and dissatisfaction.
• Investigate issues thoroughly and deliver timely, well-researched written responses.
• Negotiate resolutions aligned with policy and business risk considerations.
• Recommend service delivery improvements based on complaint trends and customer insights.

Skills

Investigating complex issues

Interpreting customer feedback

Collaboration

Clear communication

Problem-solving

Risk reduction

Customer service

Education

3+ years in insurance or LTC operations

Tools

Microsoft Office

PowerPoint

SharePoint

AWD

Job description

FedPoint is seeking a highly analytical and service-driven Claims Customer Experience Specialist (CCES) to support our expanding block of active claims. In this part‑time consultative role, you will work closely with the Senior CCES to understand and elevate the voice of the customer, improve service delivery, and strengthen satisfaction across our benefit‑eligible population.

This position is ideal for someone who excels at investigating complex issues, interpreting customer feedback, collaborating across departments, and communicating with clarity and diplomacy. You will represent FedPoint with professionalism when interacting with clients, regulators, auditors, and internal teams.

If you are motivated by problem‑solving, risk reduction, and improving the end‑to‑end customer experience, this role offers an opportunity to make meaningful impact.

What You’ll Do

Customer Satisfaction & Issue Resolution (50%)

• Communicate directly with customers regarding complaints and dissatisfaction.
• Investigate issues thoroughly and deliver timely, well‑researched written responses.
• Negotiate resolutions aligned with policy, procedure, and business risk considerations.
• Recommend service delivery improvements based on complaint trends and customer insights.
• Provide guidance to departments on appropriate complaint resolution approaches.
• Handle escalated, high‑priority issues requiring urgent attention and excellent follow‑through.
• Analyze customer satisfaction data and offer informed recommendations for improvement.
• Prepare detailed summaries and trend reports for leadership forums and operational meetings.

Complaint Workflow, Research, and Analysis (50%)

• Manage AWD escalations and complaint tickets from Customer Service and Compliance.
• Triage and prioritize incoming tickets, ensuring timely response within established workflows.
• Conduct research in collaboration with Customer Service, Claims, and other departments.
• Consult with the Senior CCES to determine the appropriate resolution path.
• Respond to inquiries via phone or formal written communication in accordance with established standards.
• Participate in risk meetings to present findings and elevate critical trends.
• Identify training or process gaps and recommend corrective actions.
• Fulfill written complaint and OPM inquiry requirements within mandated timeframes.

What You Bring

Education & Experience

• Minimum 3 years of FLTCIP experience or 3+ years in insurance or LTC operations.
• Strong knowledge of FLTCIP product requirements and claims processes.
• Experience investigating complex complaints and working within multistage complaint frameworks.
• Proficiency in Microsoft Office, particularly PowerPoint and SharePoint.
• AWD and care coordination system experience preferred.
• Strong business writing and customer service communication skills.

Schedule

Part‑Time hours, Monday-Friday - 24 Hours per week: 10am-2pm or 11am-3pm

Location

Hybrid: 2 days per week in office, Portsmouth NH

About FedPoint

FedPoint creates and operates digital benefits marketplaces that make it easy for our millions of federal and military customers to understand, select, and use their benefits. A subsidiary of John Hancock Life & Health Insurance Company, FedPoint was founded in 2002 and is headquartered in Portsmouth, NH. To learn more, visit fedpointusa.com.

Why Join Us?

At FedPoint, our mission is to create and deliver world‑class benefits experiences for our customers, clients, and business partners. We offer a dynamic work environment where innovation and collaboration are encouraged. You'll have the opportunity to make a significant impact while honing your skills and advancing your career.