Resolution Specialist

Job Summary

Managing complex member issues, the full-time remote Resolution Specialist will resolve concerns related to authorizations, claims, benefits, and provider access while ensuring a high-quality member experience through proactive outreach and case ownership.

Key responsibilities

• Manage assigned member resolution cases from intake through final closure, ensuring timely and complete resolutions
• Serve as a subject matter resource for escalated member issues, providing clear explanations of health plan benefits and services
• Collaborate with internal departments and external partners to resolve complex member concerns effectively

Required qualifications

• Minimum 1 year of healthcare experience and 1 year of contact center experience involving complex problem solving
• Experience assisting members with healthcare services including referrals, authorizations, and claims
• High School Diploma or GED required; college coursework in healthcare administration or related field preferred
• Strong verbal and written communication skills with the ability to build trust with members
• Intermediate proficiency in Microsoft Office Suite (Outlook, Word, Excel)