Member Experience Concierge - Healthcare Benefits

Guidewell, Inc.; Walker (MI); On-site; USD 43,000 - 55,000; Full time

Benefits offered by this job

Medical/dental/vision/life and global旅

Life insurance & disability

Leave programs to support personalCirc

401(k) match

Paid time off, volunteer time off, and

Voluntary benefits options

Wellness program

Job summary

Guidewell, Inc. is seeking a Member Experience Specialist (MES) in Walker, MI to collaborate with Account Executives and internal teams to improve member experiences for client plans.

You will engage with members and HR leaders, design solutions, and escalate issues to ensure high-quality service and cost-effective outcomes. The role emphasizes proactive outreach, eligibility problem-solving for Client EDI files, and serving as a concierge resource for customer service and claims.

Qualifications

• 1+ years related work experience.
• Bachelor’s degree or related equivalent work experience from an accredited university; preferably in Business, communications or experience working the medical insurance field
• Strong proficiency with Microsoft Office.
• Strong verbal and written communication skills; ability to tailor communications based on audience and business objectives.
• Comfortable working and communicating at very high levels across operational areas and working in cross-functional teams
• Maintain confidentiality and observe HIPAA requirements
• Strong customer service skills.
• Ability to work independently/autonomously and proactively as well as collaboratively as a member of a team.
• Must thrive in a team environment; team success will be heavily emphasized.
• Must be a self-starter with the ability to identify problems/issues and offer workable solutions.
• Ability to prioritize or seek information on how to best prioritize projects.
• Project confidence, high energy, enthusiasm, and high regard for client advocacy and service

Responsibilities

• Relationship management: Responsible for designing member solutions for clients, engaging directly with internal operational departments and assisting client’s Human Resource’s team members.
• Execute proactive member issue escalation resolution strategies.
• Eligibility responsibility in managing and troubleshooting Client EDI files.
• Serve members as concierge support: Serve as the immediate escalation resource for customer service reps and claims examiners, Responsible for researching claims where applicable.
• Provide member service: Outbound proactive outreach to members, as determined by the escalation, Account Executive and at the direction of client’s HR Benefits leadership Resolve member issue escalation routed through member calls or HR Benefits leadership Triage and elevate member issues to the necessary department when appropriate Engage with members to ensure previous issues have been resolved in a timely manner Support members and providers to the best experience in addressing OON facility services, provider billing challenges.
• Utilize systems to track complaints and resolutions.
• Responsible for basic reporting and analytics demonstrating service level performance for clients.

Skills

Relationship management

Escalation handling

Customer service

Cross-functional teamwork

HIPAA compliance

Verbal communication

Written communication

Problem solving

Microsoft Office

Education

Bachelor's degree in Business/Communications or related

Tools

Microsoft Office

Job description

Guidewell, Inc. is seeking a Member Experience Specialist (MES) in Walker, MI to collaborate with Account Executives and internal teams to improve member experiences for client plans.

You will engage with members and HR leaders, design solutions, and escalate issues to ensure high-quality service and cost-effective outcomes. The role emphasizes proactive outreach, eligibility problem-solving for Client EDI files, and serving as a concierge resource for customer service and claims.