Member Services Specialist

Job Summary

A company is looking for a Member Services Specialist - Benefits Navigation.

Key Responsibilities

• Serve as the primary contact for complex member escalations related to medication coverage and eligibility
• Interpret clinical protocols and insurance benefits, providing clear guidance to members
• Collaborate with Clinical Operations to identify and resolve friction points in the member journey

Required Qualifications

• 3-5 years of experience in Care Coordination, Patient Advocacy, or Clinical Operations
• Experience managing high-volume, complex member escalations
• Familiarity with Prior Authorization processes and clinical eligibility criteria
• High school diploma or equivalent required; Associate's degree preferred
• Availability to work 9am-5pm PST