Member and Provider Experience Specialist

Yuzu Health; New York (NY); Hybrid; USD 48,000 - 55,000; Full time

Benefits offered by this job

Equity opportunities

Health benefits

401K with Employer matching

Career growth opportunities

Remote capabilities

Job summary

Yuzu Health is seeking a Member and Provider Experience Specialist in New York, NY, responsible for delivering high-quality support to members and healthcare providers. This role involves handling inquiries, educating stakeholders about plan policies, and ensuring compliance with HIPAA guidelines.

The ideal candidate should have a detail-oriented mindset, possess strong communication skills, and thrive in a fast-paced environment. Join us for competitive salary and remote capabilities in a high-trust team.

Qualifications

• Strong commitment to accuracy and attention to detail.
• Ability to prioritize workload effectively in a fast-paced environment.
• Experience with innovative health insurance plan designs is a plus.

Responsibilities

• Answer inbound calls from members and providers in a professional manner.
• Provide accurate information regarding benefits, eligibility, and claims status.
• Research and resolve complex inquiries by collaborating with internal departments.
• Educate members and providers on plan policies and resources.
• Maintain confidentiality and adhere to HIPAA guidelines.
• Meet or exceed performance metrics related to call quality.

Skills

Empathy and active listening

Strong communication skills

Problem-solving

Attention to detail

Dependability

Team-oriented mindset

Job description

The Role:

The Member and Provider Experience Specialist serves as the first point of contact for members and healthcare providers, delivering high-quality, compassionate, and solution-oriented support over the phone. This role is responsible for resolving benefit, eligibility, and claims-related inquiries while ensuring an exceptional service experience for all stakeholders.

In this role, you will:

• Answer inbound calls from members and providers in a professional and courteous manner.
• Provide accurate information regarding benefits, eligibility, claims status, authorizations, and network participation.
• Research and resolve complex inquiries by collaborating with internal departments.
• Educate members and providers on plan policies, digital tools, and available resources.
• Escalate issues as appropriate to ensure timely resolution.
• Maintain confidentiality and adhere to HIPAA guidelines.
• Meet or exceed performance metrics related to call quality, timeliness, and customer satisfaction.
• Play a critical role in evolving and strengthening our Support team as we scale and take on new challenges.

Who We’re Looking For:

We’re seeking a motivated, ethical, and compassionate individual who thrives in a fast-paced, detail-oriented environment and is passionate about doing the right thing and making a difference.

Core Competencies:

• Empathy and active listening
• A strong commitment to accuracy and attention to detail
• The ability to prioritize workload effectively in a fast-paced environment
• Strong communication skills
• Problem-solving and critical thinking
• Dependability and accountability
• Team-oriented mindset

What Will Make You Stand Out:

• Experience with innovative health insurance plan designs, including Reference-Based Pricing (RBP), cash payment models, and employer-sponsored Direct Primary Care.
• Familiarity with HIPAA, CMS, or managed care guidelines.
• Bilingual skills (especially Spanish) are a plus.

Why Join Us:

• Equity opportunities
• Competitive Salary: Approximately $48-$55k in annual salary depending on experience, location, and desired equity.
• Health benefits
• 401K with Employer matching
• Career growth and development opportunities
• Remote capabilities
  • Work Hours will be Monday - Friday 9am - 6pm EST
• We are a high-trust team with radically high transparency and autonomy.