Customer Service Representative

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 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, home insurance, pet insurance, and employee discounts with preferred vendors.