Service Resolution Specialist

Job Summary

To support the Customer Service team, the remote Service Resolution Specialist will resolve second-level escalations related to claims, eligibility, benefits, and billing inquiries while documenting findings and coordinating responses with Account Management.

Key responsibilities

• Resolve second-level escalations beyond first-line CSR capability across claims, eligibility, benefits, and billing inquiries
• Investigate issues thoroughly, document findings, and record all activity in the centralized escalation tracker
• Coordinate all client-facing responses through Account Management and the Rapid Response Team, ensuring clear communication

Required qualifications

• High school diploma or GED required; associate or bachelor's degree preferred
• 2+ years of experience in health benefits customer service, claims, or member services
• Working knowledge of claims processing, eligibility, and benefit structures
• Proficiency with CRM/ticketing systems and standard office software
• Experience in a third-party administrator (TPA), health plan, or PBM environment is a plus