Customer Care Specialist

Customer Care Specialist At Umpqua Health, we're more than a healthcare organizationwe're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community. The Customer Care Specialist is responsible for providing high-quality, empathetic, and accurate support to members by responding to inquiries regarding benefits, eligibility, and general healthcare services. This role serves as a primary point of contact for member communications, handling both written and telephone interactions to ensure timely and effective resolution of questions and concerns. The position plays a key role in enhancing the members' experience by building positive relationships, advocating for member needs, and supporting access to healthcare services. Through responsive and solution-focused communication, the Customer Care Specialist contributes to the organization's commitment to delivering accessible, compassionate, and member-centered care. Essential Job Responsibilities: Serve as the primary point of contact for members via phone, email, written correspondence, and occasional in-person interactions, providing accurate information on benefits, eligibility, care coordination, and health plan navigation. Conduct proactive outreach to new and returning members to welcome them, explain available services, promote preventive care, and encourage engagement in health management and follow-up care. Listen to member concerns, research issues using multiple systems, and provide clear, empathetic, and accurate resolutions to support member understanding and trust. Collaborate with internal departments such as Care Coordination, Provider Relations, Behavioral Health, Utilization Management, and Claims to resolve member needs efficiently and in accordance with organizational policies and regulations. Document all member interactions accurately and timely in call tracking and case management systems to ensure compliance and continuity of care. Maintain strict confidentiality and comply with HIPAA and all privacy and security requirements. Educate members on health plan benefits, including provider access, prior authorization processes, pharmacy benefits, wellness programs, and available services. Connect members to community resources and social support services such as housing, food assistance, transportation, and behavioral health supports. Identify trends, recurring issues, and service gaps and provide recommendations for process improvement and enhanced member experience. Challenges: Working with a variety of personalities, maintaining a consistent and fair communication style. Satisfying the needs of a fast-paced and challenging company. Minimum Qualifications: High school diploma or equivalent required. Valid driver's license and proof of current automobile insurance required. Valid eligibility to participate in federal healthcare programs (no suspension, exclusion, or debarment from Medicare/Medicaid or similar programs). Minimum of two (2) years of customer service experience, preferably in healthcare, insurance, or public service environments. Experience working in healthcare, insurance, or public service settings. Strong communication skills, including active listening, clear verbal communication, and professional written communication. Ability to de-escalate challenging situations with empathy, patience, and professionalism. Proficiency using multiple systems simultaneously, including call center or case management platforms and Microsoft Office Suite (Outlook, Word, Excel). Experience working on diverse teams and adapting to different communication styles. Experience supporting or serving diverse communities, including communities of color. Collaborative, team-oriented mindset with a proactive approach to problem-solving and continuous service improvement. Commitment to serving diverse, underserved, rural, and vulnerable populations with cultural sensitivity and equitable service delivery. Strong professionalism, reliability, adherence to confidentiality, compliance, and accountability standards in a healthcare environment. Preferred Qualifications: Some college coursework or certifications in healthcare, human services, customer service, or medical administration. Bilingual or translation capabilities are a plus. Schedule: Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines. Salary: Wage Band: $41,600- $46,805 Benefits: Salary is dependent on skills, experience, and education Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave Medical, dental, and vision insurance 401(k) with company match (fully vested immediately) Company-sponsored life insurance and additional benefits Fitness reimbursement program Tuition reimbursement and more Why Umpqua Health? We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve. Inclusive Culture We foster a respectful, inclusive environment where employees feel valued, supported, and empowered. Growth & Development We support ongoing learning through mentorship, clear career pathways, and professional development opportunities. Work/Life Balance We promote flexibility and well-being so employees can thrive both professionally and personally. Equal Opportunity Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.