Operations Support Specialist – Healthcare Appeals & Member Advocacy

Help Improve the Healthcare Experience for Members

Are you detail-oriented, organized, and passionate about helping others? We're seeking an Operations Support Specialist to support a healthcare advocacy and appeals team by ensuring member concerns, appeals, and inquiries are accurately documented, processed, and routed for review.

In this role, you'll be the critical first point of contact in the case management process, helping ensure members receive timely support while contributing to operational excellence and regulatory compliance.

This opportunity is ideal for professionals with experience in customer service, healthcare operations, insurance, call centers, or administrative support who enjoy working in a fast-paced environment where accuracy and communication matter.

Why You'll Love This Opportunity

✅ Make a meaningful impact on member experiences and healthcare outcomes

✅ Join a collaborative team supporting complex member advocacy initiatives

✅ Gain exposure to healthcare operations, appeals, grievances, and case management

✅ Develop valuable skills in healthcare administration and regulatory processes

✅ Stable, team-oriented environment with opportunities for growth

What You'll Be Doing

Case Intake & Processing

• Receive and process incoming appeals, grievances, complaints, and advocacy requests.
• Create and maintain accurate case records within a case management system.
• Review submissions for completeness and ensure required documentation is received.
• Verify member information and supporting details.
• Route cases to the appropriate teams based on established workflows and guidelines.
• Maintain thorough and accurate documentation throughout the intake process.

Member Support & Communication

• Answer inbound calls related to appeals, grievances, and member concerns.
• Conduct outbound calls to gather additional information and provide updates.
• Assist members with understanding submission requirements and next steps.
• Deliver compassionate, professional service when handling sensitive situations.
• Document all interactions accurately and efficiently.

Administrative & Operational Support

• Process correspondence received through phone, email, fax, mail, and electronic channels.
• Digitize, organize, and attach documents to member case files.
• Monitor work queues and shared inboxes to ensure timely processing.
• Track required communications and case-related activities.
• Support inventory management and operational workflow initiatives.
• Assist with documentation retrieval and audit preparation.

Quality & Compliance

• Adhere to privacy, confidentiality, and regulatory requirements.
• Ensure all work meets established service-level expectations and timelines.
• Identify potential processing issues and escalate concerns when necessary.
• Participate in quality reviews and continuous process improvement efforts.

Cross-Functional Collaboration

• Partner with customer service, claims, clinical, and operational teams to support member needs.
• Escalate urgent situations according to established procedures.
• Contribute to departmental projects and workflow improvements.

Qualifications

Required

• 2-3+ years of experience in customer service, healthcare operations, call center, administrative support, or a related environment.
• Strong verbal and written communication skills.
• Excellent attention to detail and organizational abilities.
• Experience maintaining accurate records and documentation.
• Ability to manage multiple priorities in a fast-paced setting.
• Proficiency with data entry, case management systems, and administrative processes.

Preferred

• Experience within healthcare insurance, payer operations, or health plan environments.
• Familiarity with appeals, grievances, claims, or member services processes.
• Case management experience.
• Understanding of HIPAA and healthcare compliance requirements.

Ideal Candidate

You're someone who:

• Enjoys helping others and providing exceptional customer service.
• Thrives in a detail-focused role where accuracy matters.
• Communicates professionally and empathetically.
• Can effectively manage multiple tasks and deadlines.
• Wants to build a long-term career in healthcare operations and member advocacy.

Job Type & Location

This is a Contract position based out of Honolulu, HI.

The pay range for this position is $23.00 - $23.00/