Customer Care Specialist

Job Description

Job Description

Customer Care Specialist

Location: 3031 NE Stephens St. Roseburg, OR 97470
Employment Type: Full-Time, Exempt
Schedule: Monday–Friday, 8:00 a.m.–5:00 p.m.
Salary Range: $20.00- $22.50

ABOUT UMPQUA HEALTH
At Umpqua Health, we’re more than a healthcare organization—we’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.

POSITION PURPOSE
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.