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><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><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><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><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><strong>Benefits:</strong> </p><p><em>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 &amp; disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.</em> </p>