Senior Member Services Specialist

About the Role: 

Maven is looking for a Member Services Specialist to take on our most complex and sensitive member cases.

A few examples: a member’s reimbursement is denied and she wants it reviewed again mid-IVF cycle while her clinic is asking for payment.

Her Wallet card declines at the pharmacy leaving her $900 out of pocket.

Her employer changes plans two weeks before a scheduled transfer.

Each case involves money medical timelines and a high level of trust.

These cases live in claims appeals and reimbursement territory.

We're looking for someone who already has hands-on experience in that world — ideally someone who has served as the point of escalation on their current team — rather than someone who will build those skills here.

You’ll own cases like these from first contact through resolution by phone and in writing.

You’ll also handle everyday support volume including appointment changes login issues enrollment questions and partner programs.

The mix shifts with demand so breadth matters as much as depth.

Our Member Services team supports Maven members 7 days a week.

The shifts we’re hiring for are listed below in EST.

• Monday–Friday 1:00 p.m.–9:30 p.m.
• Tuesday–Saturday 8:30 a.m.–5:00 p.m. weekdays; 9:00 a.m.–5:30 p.m.

  Saturday

• Tuesday–Saturday 10:00 a.m.–6:30 p.m. weekdays; 9:00 a.m.–5:30 p.m.

  Saturday

• Tuesday–Saturday 1:00 p.m.–9:30 p.m. weekdays; 9:00 a.m.–5:30 p.m.

  Saturday

• Sunday–Thursday 8:30 a.m.–5:00 p.m. weekdays; 9:00 a.m.–5:30 p.m.

  Sunday

• Sunday–Thursday 1:00 p.m.–9:30 p.m. weekdays; 9:00 a.m.–5:30 p.m.

  Sunday

What You’ll Do:

• Own complex and sensitive cases end to end including appeals denied claims and applications coverage loss COBRA deductible disputes and urgent care needs.
• Take member calls on specialty workflows including conversations that have already gone badly.
• Understand what a member is actually asking for and apply the right workflow—knowing for example that a denial question and a formal appeal may require different handling.
• Owning complex and sensitive cases end to end including appeals denied claims and applications coverage loss COBRA deductible disputes and urgent care needs
• Taking member phone calls on specialty workflows including the conversations that have already gone badly
• Read what the member is actually asking for.

  A question about a denial can look identical to a request for a formal appeal but the two require different handling — the same goes for a denied application versus a denied claim.

• Investigating before you reply.

  Pull the history find where it broke and come back with an answer instead of a status update

• Keeping members updated on their timeline rather than ours when a case takes days or weeks
• Explaining coverage eligibility and reimbursement rules in language a member can act on without promising an outcome you do not control
• Driving cases that need Jira Compliance a clinic or a benefits administrator to finish and staying on them until they do
• Knowing what is yours to solve and what needs to move and handing off with enough context that nobody restarts your work
• Carrying general support volume alongside the complex work as demand shifts across programs and channels
• Noticing what members keep running into and bringing it to your manager with a fix in mind
• Working your assigned shift including evenings overnights weekends and holidays

What You’ll Bring: 

• 3-5 years of experience in claims processing appeals medical billing or benefits/health plan operations — you’ve actually worked on denials and payment disputes not just heard about them.
• Experience serving as the point of escalation on a support or claims team at an employer benefits company — the person cases got routed to when a standard rep couldn’t close them.
• A demonstrated habit of investigating before responding: pulling history finding where a case broke and coming back with an answer rather than a status update.
• Ability to explain coverage eligibility and reimbursement rules in language a member can act on without promising outcomes you don’t control.
• Experience driving cases that depend on other teams — Compliance clinics benefits administrators or a ticketing system like Jira — through to resolution.
• Judgment to know what’s yours to solve versus what needs to move and to hand off with enough context that nobody restarts the work.
• Ability to work your assigned shift including evenings overnights weekends and holidays as applicable. 

Nice to Have:

• Experience with fertility benefits specialty healthcare or financial operations.
• Experience with Zendesk Jira and Slack.
• Experience mentoring peers or supporting QA programs.
• Spanish fluency written and verbal.
• Experience in a Tier 2/3 or escalations queue at a health plan virtual healthcare platform telemedicine company fertility clinic billing team or benefits administrator.

The base salary range for this role is $82 000 - $96 000 per year.

You will also be entitled to receive equity and benefits.

Individual pay decisions are based on a number of factors including qualifications for the role experience level and skillset.

This role requires active work authorization in the US.

Maven embraces a flexible and inclusive work environment.

This role is open to candidate in: AZ DC DE FL GA HI IL KS MA MD ME MI MN MO NC NJ NM NV NY OH OR PA SC TN TX VA VT WI.

Maven is committed to supporting remote team members with the tools and collaborative culture needed to thrive regardless of location.

This policy reflects our belief that great work can happen anywhere and that flexibility enables our team to do their best work.