Healthcare Member Experience Specialist

Community Care Plan; Florida; Hybrid; USD 40,000 - 52,000; Full time

Job summary

Community Care Plan in Sunrise, FL seeks a Customer Experience Advocate to deliver professional customer service to members and providers by phone and other channels. You will address benefits, eligibility, claims, referrals, and authorizations while documenting interactions and coordinating with internal teams.

The role emphasizes HIPAA compliance, clear communication, and proactive care coordination to improve the member experience in a hybrid work setting.

Qualifications

• High school diploma or GED required.
• Knowledge of word processing, spreadsheet, internet and other computer applications.

Responsibilities

• Provide professional, responsive customer service to members and providers by phone and other channels.
• Answer inquiries about benefits, eligibility, claims, referrals, and authorizations.
• Document interactions accurately and coordinate with internal departments.
• Educate members and coordinate care to address gaps and ensure timely resolution.
• Maintain HIPAA confidentiality and professional conduct.</br>
• Escalate retention risks and assist onboarding of new members.

Skills

Excellent communication

Active listening

Problem solving

Multitasking

Documentation

HIPAA compliance

Teamwork

Independence

Education

High school diploma or GED

Tools

Epic

Job description

Community Care Plan in Sunrise, FL seeks a Customer Experience Advocate to deliver professional customer service to members and providers by phone and other channels. You will address benefits, eligibility, claims, referrals, and authorizations while documenting interactions and coordinating with internal teams.

The role emphasizes HIPAA compliance, clear communication, and proactive care coordination to improve the member experience in a hybrid work setting.