Payer Support Specialist

About the role

The Payer Support Specialist provides operational and administrative support to U.S. health insurance payer organizations and their members. The specialist handles inquiries and transactions related to health plan benefits, eligibility, claims, authorizations, appeals, grievances, and member accounts. The position requires strong communication, problem-solving, computer, and documentation skills, as well as the ability to navigate multiple payer systems while maintaining strict confidentiality. The Payer Support Specialist represents the payer organization professionally and is responsible for providing accurate, timely, and service-oriented support while following payer policies, procedures, regulatory requirements, and established workflows.

Key responsibilities

• Respond to member and authorized representative inquiries regarding benefits, coverage, claims, eligibility, and health plan information
• Research and resolve member issues using payer systems, databases, portals, and reference materials
• Explain healthcare insurance information clearly and professionally
• Provide accurate information in accordance with payer policies and procedures
• Escalate complex, sensitive, or specialized issues appropriately
• Research member eligibility and enrollment information
• Provide information regarding deductibles, copayments, coinsurance, coverage, and plan limitations
• Research claims status and processing information
• Assist with administrative inquiries regarding prior authorizations and precertifications
• Receive and document member complaints, grievances, and appeals according to established procedures

About you

• High school diploma or equivalent
• B1–C2 English proficiency, with strong verbal and written communication skills
• Previous BPO, contact center, shared-services, or customer-support experience
• Strong typing and data-entry skills
• Very good computer literacy and ability to navigate multiple applications simultaneously
• Strong CRM and computer system skills
• Strong attention to detail and accuracy
• Ability to follow detailed procedures and healthcare policies
• Ability to handle confidential and sensitive information professionally
• Ability to work in a fast-paced, metrics-driven environment