Healthcare Member Advocacy and Compliance

Our client is currently hiring a Healthcare Member Advocasy and Compliance Specialist to document, research, and address customer complaints, grievances, and inquiry escalations originating across social media and digital channels in accordance with state and federal regulatory requirements. In this customer-facing role, you will monitor social media platforms, conduct telephone and email outreach, retrieve case documentation across systems, and collaborate with cross-functional teams to deliver compliant, timely solutions for members and providers.

salary: $22 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

• Social Media & Inquiries Processing: Review, triage, and respond to incoming inquiries and complaints via dedicated social media management platforms, phone, and email within required response windows.
• Case Research & Documentation: Retrieve, organize, and assemble complete case files, supporting documentation, and medical records from multiple repositories for review by senior analysts.
• Outreach & Communication: Conduct outbound calls to members, healthcare providers, and internal partners to collect missing details and follow up on outstanding inquiries.
• Cross-Functional Collaboration: Partner with Customer Service, Health Plans, Appeals & Grievance (A&G), Compliance, and Shared Services (Claims, Utilization Management, Care Management) to investigate root causes and achieve compliant resolutions.
• Regulatory Compliance & Reporting: Maintain monthly case summaries, run standard status reports, ensure adherence to strict turnaround times, and keep sensitive member data fully confidential.
• Operational & System Support: Upload, index, and track case documentation in internal databases while assisting contact center staff through material development and queue management.

Skills

• Digital and Social Media (2 years of experience is required)
• Customer Service
• HIPAA
• Case Management (3 years of experience is required)
• Investigations
• Claims
• Document Management (2 years of experience is required)
• Microsoft Office

Qualifications

• Years of experience: 3 years
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.