Member and Provider Experience Specialist

Yuzu Health; United States; Remote; USD 48,000 - 55,000; Full time

Benefits offered by this job

Equity opportunities

Competitive Salary

Health benefits

401K with Employer matching

Job summary

Yuzu Health is seeking a Member and Provider Experience Specialist to be the first point of contact for members and healthcare providers. You will deliver high-quality, compassionate support over the phone and resolve benefits, eligibility, and claims inquiries with a focus on an exceptional service experience.

You will educate users on plan policies, digital tools, and resources, escalate when needed, and collaborate across internal teams to improve support as the company scales.

Qualifications

• Experience applying HIPAA guidelines and protecting patient information.
• Ability to understand and explain benefits, eligibility, and claims processes.
• Familiarity with health insurance plan designs and care navigation concepts.
• Strong attention to detail and accuracy in every interaction.

Responsibilities

• 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.

Skills

Empathy & listening

Accuracy & detail

Workload prioritization

Communication skills

Problem-solving

Dependability & accountability

Team-oriented mindset

Job description

Remote

Who are we?

Yuzu is a tech-enabled, vertically integrated Third Party Administrator (TPA) that powers innovative health plans centered on care navigation, capitated primary care, and real-time payments. Unlike traditional TPAs, we partner closely with plan designers who serve as care navigators, contract negotiators, and sales teams for the uniquely tailored plans they create.

We currently support thousands of employees and differentiate ourselves by helping new models of healthcare delivery come to life — enabling new ways to access and pay for care through health care coverage.

Our goal is simple: make it easy for any business to build and manage a custom health plan. We do this by efficiently processing claims, ensuring regulatory compliance, and building technology that enables custom payment flows and seamless collaboration across stakeholders. Equally important, we provide our members with high-quality support to ensure they have the guidance and assistance they need at every step of their healthcare journey.

As we continue to grow, we’re excited to welcome another talented Support Team member to help us continue delivering exceptional service and innovation.

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