Job Description

Job Posting: Claims Customer Experience Specialist

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Department:

Claims Risk Management Team

Position Type:

Full-Time, Non-Management


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About the Role

FedPoint is seeking a highly analytical, collaborative, and customer-focused

Claims Customer Experience Specialist (CCES)

to support our Senior CCES and play a key role in understanding and elevating the voice of the customer across our growing block of active claims. This role contributes directly to improving our claims service model, minimizing risk, and enhancing customer satisfaction for benefit-eligible FLTCIP clients.


As a CCES, you will analyze customer feedback, research escalated claims requests, identify trends, and help shape recommendations for improving the customer experience. You will represent FedPoint professionally with clients, regulators, and auditors, communicating complex issues with clarity and confidence. This is a consultative, non-management role that collaborates across Claims, Customer Service, Care Coordination, and Anti-Fraud, Waste & Abuse teams.

What You'll Do

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Customer Experience & Satisfaction (50%)

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.
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Appeals, Escalations & Complaint Handling (50%)

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.

What You Bring

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Education & Experience

3+ years of FLTCIP experience

OR

3+ years in insurance or long-term care operations. Strong understanding of FLTCIP products, regulations, and claims requirements. Proficiency with Microsoft Office (especially PowerPoint and SharePoint). Experience with AWD and CARE systems preferred. 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.

Location:

Portsmouth, NH

Schedule:

Monday-Friday - 40 hours per week - 2 days per week in the office

Compensation:

The typical starting salary would be between $21-23/hr, based on qualifications and experience as it relates to our requirements. This position is eligible for an annual discretionary employee bonus plan based on company metric performance as well as a full suite of benefits, listed below.

About FedPoint

FedPoint creates and operates digital benefits marketplaces that make it easy for our millions of federal and military customers to understand, select, and use their benefits. A subsidiary of John Hancock Life & Health Insurance Company, FedPoint was founded in 2002 and is headquartered in Portsmouth, NH. To learn more, visit fedpointusa.com.

Why Join Us?

At FedPoint, our mission is to create and deliver world-class benefits experiences for our customers, clients, and business partners.


We offer a dynamic work environment where innovation and collaboration are encouraged. You'll have the opportunity to make a significant impact while honing your skills and advancing your career.


In addition to working for a company with great people and an excellent reputation,

what's in it for you?


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 benefitsinclude health, dental, vision, disability, life, legal, flexible spending account (FSA) and Health Savings Account (HSA) options. 6 weeks fully-paid

parental leave*

Tuition reimbursementprogram to support career goals. Corporate

giving and matchinggifts 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 programoffering a variety of resources and activities to help support your well-being in the following areas: career, financial, mental, emotional, physical, social and community.

All offers of employment with FedPoint are conditional upon satisfactory completion of a pre-employment background check.

FedPoint is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or protected veteran status and will not be discriminated against on the basis of disability. If you believe you need a reasonable accommodation in order to search for a job opening or to submit an online application, please call (603) 433-4500.

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