Service Resolution Specialist

Point C

Service Resolution Specialist handling second-level escalations in health benefits customer service for Point C. Investigating and resolving routine client inquiries and issues efficiently.

Posted 7/15/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $45,000 - $50,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in resolving escalated customer service issues related to health benefits, claims, and billing while ensuring compliance with service level agreements. Proficient in utilizing CRM systems and documenting findings to support trend identification and root cause analysis.

Highest-signal resume keywords

Health Benefits Customer ServiceClaims ProcessingCRM/Ticketing SystemsWritten And Verbal CommunicationIssue-Resolution Support

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingEligibilityBenefit StructuresMedical CodingBilling Fundamentals

Soft Skills

Customer-Service OrientationStrong Communication Skills

Tools & Technologies

CRM SystemsZendeskStandard Office Software

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Third-Party AdministratorHealth PlanPBM EnvironmentEscalation SupportRoot Cause Analysis

About the role

Key responsibilities & impact

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
Determine root cause where possible; when the issue is an education matter, work directly with the member to provide education
Assist in escalated call audits and tracking currently being done by the Customer Service Director
Escalate to an ESR when an issue is technically complex or requires deeper expertise, providing a clear and documented handoff
Take approved immediate actions within authority and route “send-on” items to the appropriate team
Meet acknowledgment, response, and resolution SLAs based on issue severity
Coordinate all client-facing responses through Account Management and the RRT; avoid conflicting or untracked communication
Flag recurring issues and emerging patterns to the RRT to support trend identification and root cause analysis

Requirements

What you’ll need

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 (e.g., Zendesk) and standard office software
Strong written and verbal communication skills with a customer-service orientation
Experience in a third-party administrator (TPA), health plan, or PBM environment is a plus
Familiarity with medical coding and billing fundamentals is a plus
Prior escalation, second-level, or issue-resolution support experience is a plus

Benefits

Comp & perks

Comprehensive medical, dental, vision, and life insurance coverage
401(k) retirement plan with employer match
Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
Paid time off (PTO) and disability leave
Employee Assistance Program (EAP)