Customer Service Representative

<p><strong>Position Overview</strong></p><p>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.</p><p>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.</p><p>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.</p><p><br /></p><p><strong>Key Responsibilities</strong></p><p>Membership Recertification &amp; Renewal</p><ul><li>Support retention efforts across all lines of business including Medicaid, Medicare, MLTC, CHP, and EP</li><li>Conduct outbound member outreach using strategic schedules, including morning/evening hours and weekends when needed</li><li>Guide members through recertification and renewal processes</li><li>Assist with completion of recertification applications</li><li>Meet daily outreach and renewal goals</li><li>Collaborate with internal departments to resolve barriers impacting the member experience</li></ul><p><br /></p><p><strong>Enrollment &amp; Retention Support</strong></p><ul><li>Assist members with enrollment activities and plan transitions</li><li>Support re-enrollment due to administrative issues</li><li>Help members with premium payments, PCP selection, and locating providers/vendors within the network</li><li>Deliver end-to-end customer support to improve member satisfaction</li><li>Communicate effectively with members verbally and in writing</li><li>Coordinate with internal and external stakeholders to ensure complete issue resolution</li></ul><p><br /></p><p><strong>Process Improvement</strong></p><ul><li>Identify and report trends from member interactions</li><li>Recommend solutions for member complaints and dissatisfaction</li><li>Participate in process improvement initiatives and special projects</li><li>Perform additional duties as assigned</li></ul><p><br /></p><p><strong>Qualifications</strong></p><ul><li>High school diploma or equivalent required</li><li>Strong customer service and communication skills</li><li>Ability to manage multiple tasks and priorities in a fast-paced environment</li><li>Experience working with diverse populations preferred</li><li>Bilingual language skills highly preferred</li></ul><p><br /></p><p><strong>Benefits:</strong></p><p><em>Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life &amp; disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.</em></p>