Claims Customer Experience Specialist
FedPoint is a company that creates and operates digital benefits marketplaces for federal and military customers. They are seeking a Claims Customer Experience Specialist to analyze customer feedback, improve the claims service model, and enhance customer satisfaction for benefit-eligible clients.
Responsibilities
- Communicate directly with customers regarding complaints and satisfaction issues
- Investigate issues thoroughly and deliver timely, well-crafted written responses
- Negotiate appropriate resolutions under management guidance
- Recommend process and service improvements based on customer feedback
- Guide internal departments on appropriate complaint resolutions
- Escalate critical issues to senior leaders and identify trends as they emerge
- Manage priority escalations requiring in-depth research and coordinated responses
- Provide expertise on best practices, operational improvements, statistical analysis, and problem-solving
- Prepare and deliver summaries of complaint trends and survey insights for internal distribution and operational forums
- Follow AWD workflows for claims appeals, escalations, and customer service–initiated complaints
- Triage AWD tickets and assign items appropriately (Appeals, Non-appeals, Research)
- Collaborate with Claims and Customer Service to gather data and fully understand complaint circumstances
- Partner with the Senior CCES to determine when to initiate Appeal Committee Reviews and how to respond to escalations
- Deliver phone or written responses that align with established procedures and appeal guidelines
- Participate in quarterly Risk meetings to present findings and trends
- Extract and report monthly Appeal and Non-Appeal data to the Reporting Team
- Identify patterns and propose training, process, or policy improvements
- Adhere to strict timelines for written complaints and OPM inquiries
Skills
- 1+ years of FLTCIP experience, or, 1+ years in long term insurance industry or comparable field such as experience with appeals, and/or complaints/customer satisfaction/customer experience management
- Strong understanding of FLTCIP products, regulations, and claims requirements
- Proficiency with Microsoft Office (especially PowerPoint and SharePoint)
- Proven ability to write clear, professional business communication
- Customer service experience and comfort communicating by phone
- Experience navigating multi-stage complaint processes
- Background in investigating and resolving complex complaints
- Experience with AWD and CARE systems
Benefits
- Generous 401k plan: 100% match of employee's contribution, up to a maximum of 6% salary, vests immediately.
- Bonus Opportunity: Qualifying employees can earn up to 7% of their salary, based on company performance. (Inquire about eligibility with our recruiter)
- Lots of paid time off: 3 weeks’ vacation, 7 sick days, 3 personal days, and 12 paid holidays!
- Competitive benefits include health, dental, vision, disability, life, legal, flexible spending account (FSA) and Health Savings Account (HSA) options.
- 6 weeks fully-paid parental leave
- Tuition reimbursement program to support career goals.
- Corporate giving and matching gifts program.
- Volunteer program: Paid time off to volunteer and company-organized volunteering opportunities.
- A wide variety of personal, professional, and career development programs.
- Comprehensive wellness program offering a variety of resources and activities to help support your well-being in the following areas: career, financial, mental, emotional, physical, social and community.
Company Overview