Member Service Support Specialist

NationsBenefits

Member service specialist supporting members and providers with benefits, claims, and eligibility inquiries. NationsBenefits provides healthcare fintech and supplemental benefits solutions to managed care organizations.

Posted 8/5/2026full-timeRemote • Florida • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates strong customer service skills with a focus on resolving inquiries related to health plan benefits and claims. Proficient in maintaining compliance with HIPAA and healthcare regulations while ensuring accurate documentation and effective communication.

Highest-signal resume keywords

Customer Service ExperienceHIPAA ComplianceClaims AnalysisMedicare KnowledgeProblem-Solving Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data Entry SkillsClaims ReviewHealth Plan KnowledgeMedical Policies UnderstandingRegulatory Compliance

Soft Skills

Verbal CommunicationWritten CommunicationAttention to DetailMultitasking AbilityTeam Collaboration

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

HealthcareInsuranceMedicareMedicaidCall Center

About the role

Key responsibilities & impact

Answer inbound calls from members and providers regarding health plan benefits, claims, eligibility, and general inquiries
Research, locate, and provide accurate information while ensuring a positive customer experience
Resolve member service issues by identifying concerns, researching solutions, implementing appropriate resolutions, and escalating complex issues when necessary
Review and analyze claims based on diagnosis codes, procedures, provider information, medical policies, contracts, and established policies and procedures
Educate members and providers on benefits, coverage, and health plan processes
Identify members who may benefit from care management or managed care interventions and collaborate with clinical staff to facilitate appropriate services
Document all interactions accurately and thoroughly in accordance with company policies and regulatory requirements
Maintain compliance with HIPAA and applicable healthcare regulations
Meet productivity, quality, attendance, and customer satisfaction standards

Requirements

What you’ll need

High School Diploma or GED required
Strong computer and data entry skills
Excellent verbal and written communication skills
Strong problem-solving and critical-thinking abilities
Ability to multitask and navigate multiple systems simultaneously
Attention to detail and commitment to accuracy
Ability to work independently and as part of a team
Professional demeanor with a strong focus on customer satisfaction
Previous call center or customer service experience preferred
Working knowledge of Medicare and Medicaid programs preferred
Minimum of one (1) year of customer service or call center experience preferred
Healthcare, insurance, Medicare, or Medicaid experience preferred
Knowledge of health plan systems, products, policies, procedures, and departmental functions
Ability to maintain HIPAA and healthcare regulatory compliance

Benefits

Comp & perks

Website LinkedIn All Job Openings 1001 - 5000 employees Founded 2013 🏥 Healthcare 💼 Consulting 📦 Logistics 💰 Private Equity Round on 2022-04 Healthcare
Consulting
Logistics NationsBenefits is a leading healthcare technology company that specializes in providing financial technology solutions and supplemental benefits management. The company offers a variety of services, including hearing care through NationsHearing, health and wellness products via NationsOTC, and meal delivery through NationsMarket. NationsBenefits also provides specialized services like emergency assistance, healthcare transportation, and personalized health guidance using artificial intelligence. Their proprietary platforms, including Benefits Pro™, facilitate member support, benefit configuration, and e-commerce transactions. NationsBenefits focuses on improving member outcomes, closing care gaps, and enhancing satisfaction through advanced analytics and custom programs.