Remote Member Experience Specialist Healthcare
About the Role
CVS Health is looking for a Member Experience Specialist to join our remote healthcare team and serve as a trusted advocate for members navigating their health benefits. You will be responsible for delivering an exceptional, personalized experience to health plan members — answering complex benefit questions, resolving service issues, and proactively identifying opportunities to improve member satisfaction. Your work will directly shape how millions of members perceive and interact with CVS Health's integrated health services.
What You'll Do
- Serve as the dedicated point of contact for health plan members with complex benefit, coverage, or service questions
- Proactively reach out to members to conduct satisfaction check-ins and identify unmet health or service needs
- Guide members through enrollment processes, plan changes, and benefit utilization strategies
- Coordinate with internal departments including pharmacy, claims, and care management to resolve multi-faceted member issues
- Track and document member interactions and outcomes in the CRM system with accuracy and thoroughness
- Identify recurring service issues and relay feedback to process improvement teams
- Maintain compliance with CMS, state, and federal healthcare regulations throughout all member interactions
What You Bring
- 2+ years of experience in health insurance, managed care, or healthcare customer service
- Deep understanding of health benefit terminology including deductibles, copays, EOBs, and formularies
- Proven ability to de-escalate difficult conversations and turn negative experiences into positive outcomes
- Strong multitasking ability with proficiency in CRM tools and Microsoft Office Suite
- Excellent written and verbal communication skills
- Bachelor's degree in healthcare administration, communications, or a related field preferred
Why CVS Health
- Competitive pay with quarterly performance bonuses
- Comprehensive health, dental, and vision benefits effective on day one of employment
- Generous PTO policy with rollover options and paid federal holidays
- 401(k) retirement plan with up to 6% company match
- Clear career progression path within CVS Health's Member Experience and Health Services divisions
