Remote Customer Experience Specialist – Member Advocacy & Health Plan Support (Work From Home, EST/PST Hours)

About careerzynith

At careerzynith, we believe that every interaction is an opportunity to make a meaningful difference in someone’s life. As a forward-thinking organization dedicated to delivering human-centric health care solutions, careerzynith combines innovation, empathy, and expertise to create experiences that truly matter. Our mission is centered on bringing care, compassion, and clarity to every moment of your health journey, and that mission begins with the people we hire.

Our culture is built upon a foundation of heart, integrity, and accountability. We empower our team members to lead with purpose, champion the needs of those we serve, and continuously raise the standard of service excellence. When you join careerzynith, you become part of a dynamic community that values growth, collaboration, and the pursuit of better outcomes for our members, our partners, and one another.

Position Overview

careerzynith is seeking a dedicated, compassionate, and detail-oriented Remote Customer Experience Specialist – Member Advocacy & Health Plan Support to join our growing Member Services team. This is a permanent work-from-home opportunity designed for professionals located in the Eastern Standard Time (EST) or Pacific Standard Time (PST) zones who are passionate about making health care simpler, more accessible, and more personal.

As the first point of contact for our valued members, providers, and plan sponsors, you will serve as the voice and advocate of careerzynith. Every conversation you have, every question you answer, and every issue you resolve contributes directly to the trust and satisfaction of the people who depend on us. If you thrive in a fast-paced, member-focused environment and find fulfillment in helping others navigate complex systems, this role offers an exceptional opportunity to grow your career while making a tangible impact.

Key Responsibilities

The Remote Customer Experience Specialist plays a central role in shaping the member journey at careerzynith. Your day-to-day responsibilities will include, but are not limited to:

• Member Interaction & Advocacy: Serve as the primary contact for members reaching out via telephone, written correspondence, and digital channels. Address inquiries ranging from basic to complex with empathy, professionalism, and accuracy.
• Personalized Guidance: Engage, consult, and educate members based on their unique needs, preferences, and understanding of their health plans. Champion a personalized approach that builds lasting emotional connections and trust.
• Issue Resolution: Answer questions, troubleshoot concerns, and resolve issues related to benefits, claims, and plan provisions. Triage resulting rework to the appropriate internal teams to ensure seamless follow-through.
• Documentation & Tracking: Accurately document and track all member, provider, and plan sponsor interactions within our systems, ensuring complete and compliant records for every contact.
• Plan Navigation Support: Guide members through their plan of benefits, careerzynith policies, and procedures while maintaining awareness of relevant regulatory guidelines.
• Proactive Engagement: Anticipate member needs, provide unasked but valuable information such as additional plan details, self-service tools, and wellness resources, and take full accountability for understanding each member’s unique situation.
• Financial Decision-Making: Use careerzynith’s customer service threshold framework to make financial decisions that resolve member issues effectively and fairly.
• Rights & Responsibilities Education: Clearly explain member rights and responsibilities in accordance with contractual obligations.
• Referral & Authorization Processing: Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals (both member and provider-initiated) via target systems.
• Provider Support: Educate providers on self-service options, assist with credentialing and re-credentialing issues, and respond to requests related to litigation and legal documentation.
• File Review & Audit Assistance: Handle extensive file review requests, assist in preparing complaint trend reports, and compile claim data for customer audits as needed.
• Medical Necessity & Coverage Verification: Determine medical necessity, applicable coverage provisions, and verify member plan eligibility for incoming correspondence and internal referrals.
• Appeals & Pre-Authorizations: Manage incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management, and perform detailed claim history reviews to ensure accurate tracking of benefit maximums, coinsurance, and deductibles.
• Data Maintenance & Reporting: Perform financial data maintenance as needed and use available system tools to produce high-quality letters, spreadsheets, and reports in response to inquiries.

Essential Qualifications

To thrive in this role, candidates should bring the following:

• Customer Service Experience: Demonstrated experience in a transaction-based environment, such as a call center or retail setting, with a proven ability to be empathetic, compassionate, and solution-oriented.
• Production Environment Background: Prior experience working in a high-volume, metrics-driven production environment where quality and efficiency are equally prioritized.
• Communication Skills: Excellent verbal and written communication skills, with the ability to explain complex information in a clear, friendly, and relatable manner.
• Technical Proficiency: Comfort using multiple software systems, navigating digital tools, and documenting interactions with precision.
• Problem-Solving Mindset: Strong analytical and critical thinking skills, with the ability to assess situations quickly and make sound decisions that align with member needs and organizational guidelines.
• Time Zone Flexibility: Must reside in and be available to work standard hours aligned with EST or PST.
• Educational Foundation: High School diploma or GED equivalent required.

Preferred Qualifications

While not required, the following qualifications will help candidates stand out:

• Prior experience in health care, insurance, or member services environments.
• Familiarity with claims processing, benefits administration, or related workflows.
• Experience handling appeals, grievances, or pre-authorizations.
• Bilingual or multilingual capabilities.
• Post-secondary education in business, communications, health administration, or a related field.

Core Competencies for Success

At careerzynith, we recognize that exceptional service is built on a foundation of strong competencies. Successful team members in this role will demonstrate:

• Empathy & Compassion: The ability to genuinely understand and respond to the emotions and concerns of others.
• Adaptability: Comfort with change, ambiguity, and the evolving needs of a dynamic industry.
• Accountability: A strong sense of ownership for outcomes, follow-through, and continuous improvement.
• Resilience: The ability to maintain composure, professionalism, and positivity in challenging situations.
• Collaboration: A team-oriented mindset with a willingness to support colleagues and contribute to collective success.
• Attention to Detail: Precision in documentation, data entry, and adherence to regulatory and procedural standards.

Career Growth & Development Opportunities

careerzynith is deeply invested in the professional development of our team members. When you join us, you gain access to a wealth of growth opportunities, including:

• Comprehensive onboarding and continuous training programs designed to deepen your expertise in health care customer service.
• Clear career pathways into roles such as Team Lead, Quality Analyst, Training Specialist, and Member Services Management.
• Tuition assistance and education reimbursement programs to support your continued learning.
• Free development courses covering leadership, communication, technical skills, and industry-specific knowledge.
• Mentorship and peer networking opportunities to help you build meaningful professional relationships.

Work Environment & Company Culture

At careerzynith, we believe that a positive, supportive work environment is essential to delivering exceptional service. As a remote team member, you will enjoy:

• The flexibility and comfort of working from home, with the resources and tools needed to succeed.
• A culture that values heart, inclusion, and diversity, where every team member’s voice is heard and respected.
• A commitment to well-being, with programs designed to support your physical, emotional, and financial health.
• Regular engagement through virtual team-building events, recognition programs, and company-wide celebrations.

Compensation & Benefits

careerzynith offers a competitive compensation package and a comprehensive suite of benefits designed to reward and support our team members:

• Pay Range: The typical hourly pay range for this role is $17.00 – $25.65, based on experience, education, geography, and other relevant factors.
• Health Benefits: Full medical, dental, and vision coverage for eligible employees.
• Retirement Savings: 401(k) retirement savings plan with company match opportunities, plus an Employee Stock Purchase Plan for eligible team members.
• Insurance Coverage: Fully paid term life insurance, along with short-term and long-term disability benefits.
• Well-Being Programs: Access to numerous well-being initiatives, including mental health resources, fitness incentives, and wellness coaching.
• Education Assistance: Financial support for continued education, certifications, and skill-building courses.
• Employee Discounts: Discounts on retail products, services, and programs with participating partners.
• Paid Time Off: Generous PTO and vacation pay, plus paid holidays throughout the calendar year, consistent with state regulations and company policies.

Equal Opportunity Employment

careerzynith is proud to be an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.

How to Apply

If you are ready to bring your heart to work, make a meaningful impact in the lives of others, and grow your career with an organization that truly values its people, we encourage you to apply today. Join careerzynith and become part of a team that is transforming health care, one heartfelt interaction at a time.

Take the next step in your career and discover what it means to work with purpose at careerzynith. We look forward to welcoming you to our team.

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