Healthcare Customer Advocate & Escalation Specialist

Liberty Health; Wilmington (NC); On-site; USD 38,000 - 48,000; Full time

Job summary

Liberty Advantage is seeking a dedicated Customer Service Specialist to support members and providers with escalated issues and enrollment tasks. This full-time role emphasizes education on benefits, claims information, and coordination with care providers to ensure timely assistance.

Responsibilities include resolving appeals, researching complex issues, and triaging prior authorizations. The candidate should have strong communication skills and the ability to work independently in a fast-paced

Qualifications

• Excellent listening, verbal, written and interpersonal communication skills.
• High level of professionalism and confidentiality with a strong customer service focus.
• Can adapt to operational needs with excellent follow-up skills.
• Must be self-motivated with the discipline to work independently.
• Must have a valid driver’s license.
• Proven ability to communicate concisely with all staff levels.

Responsibilities

• Handle escalated calls from members/providers or vendors resolving issues, preferably the first time.
• Educate members on benefits and resolving claim information or setting up enhanced benefits.
• Intervene with care providers for appointment scheduling or connections with internal specialists.
• Assist with enrollment team to set up new members.
• Document and resolve Appeals and Grievances within CMS time frames.
• Research complex issues across databases and collaborate to resolve escalated issues.
• Set up and triage prior authorization requests, working through clinical protocols.

Skills

Customer service

Communication

Confidentiality

Self-motivation

Driver's license

Education

High School Diploma/GED

Job description

Liberty Advantage is seeking a dedicated Customer Service Specialist to support members and providers with escalated issues and enrollment tasks. This full-time role emphasizes education on benefits, claims information, and coordination with care providers to ensure timely assistance.

Responsibilities include resolving appeals, researching complex issues, and triaging prior authorizations. The candidate should have strong communication skills and the ability to work independently in a fast-paced