Member and Provider Experience Specialist

🕒 6 days ago

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Yuzu

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2022

🏥 Healthcare

🛡️ Insurance

☁️ SaaS

Healthcare • Insurance • SaaS

Yuzu is a technology platform that lets organizations design, launch, and operate custom health plans and modernize third-party administrator (TPA) workflows. It provides a Benefits Builder to configure tiers, accumulators, and benefits; integrations with PBMs, stop-loss carriers, and other vendors; automated document generation and e-signature; web-based portals for employers, members, and vendors; in-house claims adjudication and payment infrastructure with real-time auto-ledgering; and reporting and support tools. Yuzu emphasizes white-labeling so customers can present fully branded plans and handles end-to-end plan operations from onboarding to live plan management.

📋 Description

• Answer inbound calls from members and providers in a professional and courteous manner. • Provide accurate information regarding benefits, eligibility, claims status, authorizations, and network participation. • Research and resolve complex inquiries by collaborating with internal departments. • Educate members and providers on plan policies, digital tools, and available resources. • Escalate issues as appropriate to ensure timely resolution. • Maintain confidentiality and adhere to HIPAA guidelines. • Meet or exceed performance metrics related to call quality, timeliness, and customer satisfaction. • Play a critical role in evolving and strengthening our Support team as we scale and take on new challenges

🎯 Requirements

• Experience with innovative health insurance plan designs, including Reference-Based Pricing (RBP), cash payment models, and employer-sponsored Direct Primary Care • Familiarity with HIPAA, CMS, or managed care guidelines • Bilingual skills (especially Spanish) are a plus

🏖️ Benefits

• Equity opportunities • Competitive Salary • Health benefits • 401K with Employer matching • Career growth and development opportunities • Remote capabilities • Work Hours will be Monday - Friday 9am - 6pm EST • High-trust team with radically high transparency and autonomy