Member Issue Resolution Analyst

Role overview

Join a global healthcare organization focused on improving the way people access care through technology, services, and collaboration. In this position, you will work on challenging member claim problems that span several processing systems and entities. The goal is not only to fix the immediate issue, but also to understand why it happened and help stop it from happening again.

You will work in a team environment that values inclusion, continuous improvement, and delivering a better experience for members. The work involves close coordination with internal departments and outside partners to improve accuracy, reduce repeat contacts, and strengthen outcomes across delegated and value-based care arrangements.

About the team

The VBR Operations - Member Issue Resolution team operates in a busy, collaborative setting where complex cross-system issues are handled with urgency and care. The team works with business partners and external organizations to improve accountability, streamline processes, and create lasting solutions that support members.

The team culture emphasizes proactive problem-solving, learning, and consistency in solving issues that affect members across multiple care and claims workflows.

What you will do

• Take ownership of complicated member claim issues from start to finish across multiple platforms, including investigation, resolution, and prevention steps.
• Handle escalated and regulatorily sensitive issues across different lines of business while meeting required timelines, quality standards, and performance goals.
• Study claim-processing and cost-share trends to uncover recurring problems and broader system issues.
• Work with internal teams and external partners to correct errors, apply fixes, and improve overall processing accuracy.
• Collaborate with the Cost Share team to resolve cost-share related concerns and ensure the impact to members is understood and addressed.
• Spot opportunities for better processes and automation, document observations, and help drive solutions that reduce the number of repeated issues.
• Assess member inquiries in a complete way, resolving the immediate matter while also identifying any additional effect on the member.
• Combine similar items in the work queue to support efficient and scalable resolution methods.
• Share findings, recommendations, and potential risks clearly with both internal and external stakeholders so action can be taken quickly.

What success in this role looks like

• You can resolve difficult issues on your own with limited direction.
• You focus on underlying causes rather than only treating symptoms.
• You use analytical and creative thinking to work through unclear or unusual situations.
• You identify risks and improvement opportunities before being asked.
• You can work effectively across multiple systems, teams, and workflows.
• You deliver fixes that improve the member experience and lower repeat issue volume.

Required qualifications

• A bachelor’s degree, or equivalent experience in healthcare operations.
• At least 3 years of experience in claims operations, issue resolution, or healthcare servicing.
• Hands-on experience managing complex claim issues across more than one system.
• Proven ability to perform root-cause analysis and independently drive resolution.
• Strong analytical and problem-solving ability with the confidence to think beyond standard procedures.
• Comfort using Microsoft 365 tools such as Excel, Word, PowerPoint, Teams, and SharePoint.
• Ability to juggle competing priorities in a fast-moving environment.
• Strong written and spoken communication skills.
• Capacity to work both independently and as part of a team, with a proactive approach to issue identification and resolution.
• Ability to work through ambiguity, learn quickly, and apply new ideas as systems and processes evolve.

Preferred experience

• Familiarity with Cosmos, USP Cirrus, CSP Facets, or ATS.
• Strong understanding of delegated claims and value-based care models.
• Experience working with risk entities or delegated providers.
• Exposure to process improvement, automation, or continuous improvement work.

Eligibility

Applicants must already be eligible to work and remain indefinitely in the country where they are applying, without restrictions. Proof of eligibility will be required during the application process.

Additional information

The employer is committed to diversity, inclusion, health equity, and equal employment opportunity. The workplace is described as drug-free. The organization also highlights a mission to improve health outcomes and support equitable care for all communities.

Reference code: #BBMEMEA