Service Resolution Specialist

Job not on LinkedIn

🔥 14 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Point C

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

📋 Compliance

🤝 B2B

Healthcare Insurance • Compliance • B2B

Point C is a trusted health benefits partner that delivers meaningful solutions for brokers and their self-funded clients. The company specializes in administering benefit plans, managing medical costs effectively, and ensuring a high-value experience for members. With a focus on vendor integration and data-driven insights, Point C aims to simplify the benefit process while providing access to quality care and innovative mobile tools for its clients and their employees.

📋 Description

• 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

• 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

• 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)