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About the Role

The Member Service Specialist is responsible for member status visibility, complaint prevention, coordination issue resolution, and compliance support. This role serves as the primary contact for members seeking updates regarding referrals, services, authorizations, and care coordination activities, bridging communication gaps between various stakeholders to ensure members receive accurate information and timely assistance. This position plays a critical role in reducing complaints, improving member satisfaction, and supporting accountability and reporting obligations.

Responsibilities

Respond to member inquiries regarding referrals, services, authorizations, and care coordination.
Track referral status and provide timely updates to members and stakeholders.
Investigate and resolve member concerns in collaboration with care managers, providers, and community partners.
Document member interactions, complaints, resolutions, and follow-up activities.
Monitor referral outcomes and identify barriers to service completion.
Support compliance reporting, quality initiatives, and audit preparation.
Maintain accurate records and contribute to process improvement efforts.

Requirements

Bachelor's degree in social work, Human Services, Public Health, Healthcare Administration, Nursing, Psychology, or a related field.
Minimum 3 years of experience in member services, healthcare, care coordination, customer service, or a related area.
Strong communication, problem-solving, and customer service skills.
Ability to manage sensitive situations with professionalism, empathy, and confidentiality.

Skills

Medicaid
Managed care
Healthcare navigation
Social care programs
Referral management systems
Electronic records
Complaint tracking
Community resources
Care coordination workflows
Bilingual or multilingual skills

Location

Hybrid

Work Type

Hybrid

Experience Level

3 years of experience

Education Level

Bachelor's degree

Salary/Compensations

$23.00 – $24.00 per hour

Benefits

401(k) with Company Match
Medical Insurance
Dental Insurance
Vision Insurance
Health Savings Account (HSA)
Flexible Spending Account (FSA)
Paid Time Off (PTO)
Mileage Reimbursement

About the Company

Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers dedicated to improving healthcare outcomes for underserved populations across Upstate New York.
Through integrated primary care, behavioral health, and social care services, FLIPA works collaboratively with healthcare providers and community organizations to address the whole-person needs of the communities we serve.