Support Services Specialist

This is a Fully Remote Job About Our Client: The organization operates as a tech-enabled, vertically integrated Third Party Administrator (TPA) in the healthcare industry. It focuses on enabling innovative health plans that emphasize care navigation, capitated primary care, and real-time payments. By partnering closely with plan designers who act as care navigators and contract negotiators, the organization supports tailored healthcare plans. It serves thousands of employees and facilitates new healthcare delivery models that offer alternative ways to access and pay for care. About the Opportunity: The SUPPORT SERVICES SPECIALIST serves as the primary contact for members and healthcare providers, providing compassionate and solution-focused support primarily via phone. This role addresses benefit, eligibility, and claims inquiries while ensuring a positive service experience. The position is essential for maintaining quality interactions and supporting the organization's evolving service capabilities as it grows. Responsibilities: Handle inbound calls from members and providers professionally. Provide accurate information on benefits, eligibility, claims status, authorizations, and network participation. Investigate and resolve complex inquiries through collaboration with internal teams. Educate members and providers on plan policies, digital tools, and resources. Escalate issues appropriately to ensure timely resolution. Maintain confidentiality and comply with HIPAA guidelines. Achieve or exceed performance metrics related to call quality, timeliness, and customer satisfaction. Contribute to the development and strengthening of the Support team. Requirements: Empathy and active listening skills. Strong attention to accuracy and detail. Ability to prioritize tasks in a fast-paced environment. Effective communication skills. Problem-solving and critical thinking abilities. Dependability and accountability. Team-oriented approach. Preferred: Experience with innovative health insurance plan designs such as Reference-Based Pricing, cash payment models, and employer-sponsored Direct Primary Care. Preferred: Familiarity with HIPAA, CMS, or managed care guidelines. Preferred: Bilingual skills, especially Spanish. Pay Range and Compensation Package: Approximately $48,000 to $55,000 annually, depending on experience, location, and equity desires. Benefits & Perks: Health benefits. 401K with employer matching. Equity opportunities. Remote work capabilities. Career growth and development opportunities. Work hours Monday through Friday, 9 am to 6 pm EST. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note: TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.