Customer Care Specialist
$41,600–$46,805 year
On-site · Roseburg, Oregon, United States
Job Summary
The Customer Care Specialist will serve as the primary contact for members via phone, email, written correspondence, and occasional in-person interactions to provide accurate information on benefits, eligibility, care coordination, and health plan navigation. Responsibilities include proactive outreach to welcome and engage members, researching issues across multiple systems, delivering empathetic resolutions, collaborating with Care Coordination, Provider Relations, Behavioral Health, Utilization Management, and Claims, documenting interactions in call tracking/case-management systems, maintaining HIPAA/privacy compliance, educating members on benefits (provider access, prior authorization, pharmacy benefits, wellness programs), connecting members to community resources, and identifying trends to drive process improvements for better member experience.
Required Qualifications
- High school diploma or equivalent required
- Valid driver’s license and proof of current automobile insurance required
- Valid eligibility to participate in federal healthcare programs (no suspension, exclusion, or debarment from Medicare/Medicaid or similar programs)
- Minimum of two (2) years of customer service experience, preferably in healthcare, insurance, or public service environments
- Experience working in healthcare, insurance, or public service settings
- Strong communication skills, including active listening, clear verbal communication, and professional written communication
- Ability to de-escalate challenging situations with empathy, patience, and professionalism
- Proficiency using multiple systems simultaneously, including call center or case management platforms and Microsoft Office Suite (Outlook, Word, Excel)
- Experience working on diverse teams and adapting to different communication styles
- Experience supporting or serving diverse communities, including communities of color
- Collaborative, team-oriented mindset with a proactive approach to problem-solving and continuous service improvement
- Commitment to serving diverse, underserved, rural, and vulnerable populations with cultural sensitivity and equitable service delivery
- Strong professionalism, reliability, adherence to confidentiality, compliance, and accountability standards in a healthcare environment
- Some college coursework or certifications in healthcare, human services, customer service, or medical administration
- Bilingual or translation capabilities are a plus
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