Member Experience Specialist Jobs

The focus of a Member Experience Specialist is to drive increased member satisfaction and experience through near real time service recovery efforts. MESs help leaders understand what members are telling us about their interactions, opportunities for course corrections and improve member retention.

The ideal candidate will have a passion for service and care excellence. They will demonstrate excellent verbal and written communication skills, as well as high emotional intelligence. You should be detail oriented and have the ability to effectively problem-solve with respect and empathy. Additionally, you should be comfortable taking ownership of your piece of the business and have a desire to collaborate with leadership to make decisions that will have a positive impact on the people we serve.

Responsibilities

• Investigate and develop corrective action plans for quality issues and member complaints.
• Demonstrate proficiency in navigating insurance plan details and customer information provided by Included Health.
• Enhance clinical outcomes for members and educate members on the benefits available to them.
• Utilize de-escalation techniques to effectively drive to resolution and positive member outcomes.
• Assist in driving ongoing strategy for service recovery.
• Create and manage tickets, including complete, accurate, clear and concise documentation.
• Follow events through completion of investigation and action plan. * Conduct inbound/outbound interactions (call, chat, email) with members to solve for their issue, treating each with empathy and respect.
• Perform other duties as assigned.
• Work in collaboration with internal stakeholders as part of an interdisciplinary team to advocate on behalf of patients, care team, family/caregiver(s), payers, and community resources using care plan development and adherence.

Qualifitcations

• Knowledge in claims and navigation.
• Excellent customer service skills - our members are top priority and we are their advocates. Be empathetic. You’ll work with members and their families who are going through challenging times. Ability to keep perspective, be empathetic, be efficient and reassure.
• Ability to adapt rapidly to process changes.
• Demonstrated ability to critically think and solve complex situations, experience in motivational interviewing.
• Thrives in a fast-paced environment and quick learner.
• Proficiency with technology; experience with Google apps, Apple products, and customer relationship management software a plus.
• 3+ years of experience in customer service.
• College degree preferred.
• Passionate about excellence in customer service.
• Effective time management, demonstrating high organization and attention to detail with tasks and deadlines.
• Excellent written and verbal communication skills.
• Familiarity with VoIP phone systems (e.g., CXOne) and being comfortable with communicating on the phones majority of the day.
• Ability to work from a secure home office, free from distractions.

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com .

Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.