Health Plan Specialist - Medicaid

Job Description

Job Description

We are looking for a customer-focused Health Plan Specialist to support members through high-volume inbound service specifically related to Medicaid. In this customer-focused role, you will handle a high volume of inbound calls, guide members through questions related to coverage, billing, and enrollment, and work toward complete resolution with accuracy and empathy. This position is well suited to someone who communicates clearly, stays organized in a fast-paced environment, and is comfortable working within a structured virtual training and remote support setting.

Responsibilities:

• Respond to inbound member calls and provide knowledgeable support for benefit, billing, enrollment, and health plan inquiries.

• Manage a heavy daily call volume during peak periods while maintaining professionalism, accuracy, and a service-first approach.

• Take ownership of each case from initial contact through final resolution, ensuring details are fully documented and follow-up is completed on time.

• Use internal systems, online resources, and multiple applications at once to research concerns and deliver clear answers to members.

• Assist individuals facing more involved service issues by applying sound judgment, empathy, and problem-solving skills.

• Maintain complete and accurate records of member interactions, actions taken, and outcomes achieved.

• Participate fully in virtual training, team sessions, and ongoing coaching activities while remaining engaged on camera as required.

• Support a positive team environment by collaborating with colleagues and contributing to a strong member experience

• High school diploma or equivalent work experience.
• At least 2 years of call center experience in a customer service environment.
• Ability to communicate effectively in both verbal and written formats when handling sensitive or detailed member concerns.
• Proficiency with Microsoft Office, multi-screen workstations, and navigating several systems simultaneously.
• Strong attendance record and the ability to work assigned shifts Monday through Friday within a flexible daytime schedule.
• Stable hard-wired high-speed internet connection with ethernet capability; satellite, hotspot, and Wi-Fi-only connections are not acceptable.
• Ability to maintain a detail-focused, distraction-free remote workspace and use company-provided equipment, including headset and monitors.
• Health insurance or related healthcare customer service experience, including Medicaid or Medicare knowledge, is strongly preferred.