Member Resolution Specialist

OptiMed Health Partners; Kalamazoo (MI); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Remote work option

HIPAA compliance training

Job summary

OptiMed Health Partners is seeking a Member Resolution Expert in a hybrid work arrangement to own the resolution of complex member issues. You will investigate across pharmacy and reimbursement systems, coordinate cross-functional actions, and communicate findings to members and stakeholders with clarity and empathy.

The role emphasizes strong knowledge of pharmacy operations, reimbursement processes, and HIPAA-compliant collaboration across multiple departments to improve the member experience

Qualifications

• Associate degree or equivalent in a healthcare-related field or experience.
• 3+ years of experience in healthcare operations, specialty pharmacy, infusion pharmacy, reimbursement, or related environment.
• Strong investigative and analytical capabilities with excellent communication.

Responsibilities

• Member Issue Resolution: own complex member issues, escalations, complaints, and service recovery opportunities.
• Research & Analysis: investigate operational, reimbursement, billing, and service-related issues across multiple systems.
• Cross-Functional Collaboration: coordinate with multiple teams to ensure timely resolution.
• Communication & Member Advocacy: clearly explain processes and provide empathetic updates to members.
• Process Improvement: identify workflow improvements and partner with leadership to implement them.

Skills

Healthcare operations

Analytical thinking

Communication skills

Cross-functional collaboration

Problem solving

Education

Associate degree or equivalent

Bachelor's degree preferred

Tools

CRM systems

EHR systems

Claims systems

Microsoft Office

Job description

OptiMed Health Partners is seeking a Member Resolution Expert in a hybrid work arrangement to own the resolution of complex member issues. You will investigate across pharmacy and reimbursement systems, coordinate cross-functional actions, and communicate findings to members and stakeholders with clarity and empathy.

The role emphasizes strong knowledge of pharmacy operations, reimbursement processes, and HIPAA-compliant collaboration across multiple departments to improve the member experience