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FedPoint · 12 hours ago

Claims Customer Experience Specialist

Portsmouth, NH

Full-time

Hybrid

Entry Level

$21/hr - $25/hr

1+ years exp

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.

BillingInformation TechnologyInsuranceSecurity

Culture & Values

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

Qualification

FLTCIP experienceLong term insurance knowledgeMicrosoft Office proficiencyAWD system experienceCARE system experienceBusiness communicationCustomer service experienceComplaint resolutionInvestigative skills

Required

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

Preferred

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.