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