REMOTE Benefits Support Specialist

Job Title

Required Skills & Experience
• Experience supporting Medicare Advantage, D-SNP, integrated Medicare-Medicaid plans, supplemental benefits, or Nations Benefits/vendor-administered programs.
• Knowledge of CMS supplemental benefit and SSBCI requirements; familiarity with benefit configuration, eligibility files, vendor testing, reporting, invoice reconciliation, Service Now, Facets, CRM, or comparable systems.

Collaborate with contracted vendors to ensure smooth execution of program services.
• Monitor vendor performance, adherence to contract terms, and service level agreements.
• Establish and maintain strong working relationships with vendors through regular communication and meetings.
• Address any vendor-related concern promptly and ensure compliance with program standards.
• Act as the point of contact for program beneficiaries regarding inquiries, issues, and escalations.
• Investigate and resolve member concerns in a timely and satisfactory manner.
• Collaborate with cross-functional teams to address and resolve complex member issues.
• Analyze root causes of member complaints and work on preventive solutions.
• Ensure compliance with regulatory guidelines while resolving member issues.
• Analyze program data to identify trends, patterns, and areas for improvement.
• Prepare regular reports on program performance, member feedback, and vendor compliance.
• Make recommendations based on data analysis to enhance program effectiveness.
• Maintain open lines of communication with internal teams, vendors, and program beneficiaries.