Member Services Specialist

mavenclinic; United States; Remote; USD 50,000 - 70,000; Full time

Benefits offered by this job

Remote-first policy

Hybrid work options

Parental leave stipend

Career development stipend

401(k) matching

Job summary

Maven Clinic is seeking a Member Services Specialist to manage the most complex and sensitive member cases across fertility, maternity, parenting, and midlife care. The role blends case ownership with high-volume support, delivered via phone and written communication seven days a week in Eastern Time.

You will own end-to-end cases, handle appeals and denied claims, and coordinate with compliance and benefits teams when escalation is needed.

Qualifications

• Experience handling complex, sensitive member cases involving money, medical timelines, or both.
• Strong written and verbal communication skills for phone and written support.
• Ability to read between the lines and select the correct workflow.
• Sound judgment on promises versus third-party outcomes.
• Willingness to work evening or weekend shifts.
• Authorized to work in the United States; remote work is supported across a wide range of states.

Responsibilities

• Own complex cases end-to-end, including appeals, denied claims and applications, coverage loss, COBRA issues, deductible disputes, and urgent care needs
• Take member phone calls on specialty workflows, including conversations where prior interactions have gone badly
• Distinguish between similar-sounding requests and apply the correct workflow
• Investigate before replying by pulling full history, identifying where the process broke, and returning with an answer rather than a status update
• Communicate coverage, eligibility, and reimbursement rules clearly, without overpromising outcomes
• Coordinate cross-functionally with compliance, clinic partners, and benefits administrators when cases require escalation

Skills

Complex case handling

Written and verbal communication

Decision making

Remote work readiness

Evening/weekend shifts

Customer service

Tools

Jira

Job description

Role overview

A virtual women's and family health organization is hiring a Member Services Specialist to handle its most complex and sensitive member cases. The role blends high-stakes case ownership with day-to-day support volume, balancing phone and written communication across fertility, maternity, parenting, and midlife care programs. The team operates seven days a week, with multiple shift options available in Eastern Time.

Responsibilities

• Own complex cases end-to-end, including appeals, denied claims and applications, coverage loss, COBRA issues, deductible disputes, and urgent care needs
• Take member phone calls on specialty workflows, including conversations where prior interactions have gone badly
• Distinguish between similar-sounding requests (for example, a denial question versus a formal appeal, or a denied application versus a denied claim) and apply the correct workflow
• Investigate before replying by pulling full history, identifying where the process broke, and returning with an answer rather than a status update
• Communicate coverage, eligibility, and reimbursement rules clearly, without overpromising outcomes
• Coordinate cross-functionally with compliance, clinic partners, and benefits administrators when cases require escalation

Requirements

• Experience handling complex, sensitive customer or member cases involving money, medical timelines, or both
• Strong written and verbal communication skills, with the ability to support members by phone and in writing
• Ability to read between the lines of a member request and choose the right workflow
• Sound judgment on what can be promised versus what depends on a third party
• Comfort working a scheduled shift that may include evenings or weekends
• Authorization to work in the United States; remote work is supported across a wide range of states

Nice to have

• Background in healthcare, insurance, benefits administration, or a related regulated environment
• Familiarity with fertility, maternity, or family-building workflows
• Experience using case management or ticketing tools such as Jira

Benefits and work setup

• Remote-first policy with tools and culture designed for distributed teams
• Access to the organization's full care platform and specialists, including mental health, reproductive health, family planning, and pediatrics
• Wellness partnerships supporting whole-self care
• Hybrid work options with in-office meals and team collaboration days
• 16 weeks of fully paid parental leave plus a new parent stipend (after one year of tenure)
• Annual professional development stipend and access to a personal career coach
• 401(k) matching with immediate vesting for U.S.-based employees
• Comprehensive medical, dental, and insurance plan options