Customer Service Representative

Job Description

Job Description

Position Overview

The Customer Success Specialist I supports Client members and key stakeholders throughout the customer journey. This role serves as a subject matter expert on Client processes and acts as a liaison to ensure members receive timely resolutions and support.

The ideal candidate is customer-focused, detail-oriented, and passionate about delivering an exceptional member experience that drives retention and satisfaction through both inbound and outbound outreach.

The Customer Success Specialist I will oversee member retention activities and serve as a single point of contact for issues escalated to the Customer Success department.

Key Responsibilities

Membership Recertification & Renewal

• Support retention efforts across all lines of business including Medicaid, Medicare, MLTC, CHP, and EP
• Conduct outbound member outreach using strategic schedules, including morning/evening hours and weekends when needed
• Guide members through recertification and renewal processes
• Assist with completion of recertification applications
• Meet daily outreach and renewal goals
• Collaborate with internal departments to resolve barriers impacting the member experience

Enrollment & Retention Support

• Assist members with enrollment activities and plan transitions
• Support re-enrollment due to administrative issues
• Help members with premium payments, PCP selection, and locating providers/vendors within the network
• Deliver end-to-end customer support to improve member satisfaction
• Communicate effectively with members verbally and in writing
• Coordinate with internal and external stakeholders to ensure complete issue resolution

Process Improvement

• Identify and report trends from member interactions
• Recommend solutions for member complaints and dissatisfaction
• Participate in process improvement initiatives and special projects
• Perform additional duties as assigned

Qualifications

• High school diploma or equivalent required
• Strong customer service and communication skills
• Ability to manage multiple tasks and priorities in a fast-paced environment
• Experience working with diverse populations preferred
• Bilingual language skills highly preferred

Benefits:

Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Equal Employment Opportunity

[Pride Health] is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment

[Pride Health] is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Company Description

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors.

Equal Employment Opportunity
[Hiring Entity Name] is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment
[Hiring Entity Name] is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Company Description

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors. \r\n\r\nEqual Employment Opportunity\r\n[Hiring Entity Name] is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.\r\n\r\n \r\n\r\nFair Chance Employment\r\n[Hiring Entity Name] is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.\r\n\r\n \r\n\r\nAccommodations\r\nWe are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.