Senior Member Services Specialist, Maven Clinic

• Investigate before responding: review the history, identify where an issue broke down, and provide an answer rather than a status update
• Keep members informed based on their timeline, especially when resolution takes days or weeks
• Explain coverage, eligibility, and reimbursement rules clearly and accurately, without promising outcomes you don’t control
• Drive cases requiring Jira, Compliance, clinics, or benefits administrators through resolution and follow through until they’re closed
• Know what you can solve independently, what needs to be escalated, and how to hand off with enough context that work doesn’t start over
• Balance complex escalations with general support volume as demand shifts across programs and channels
• Identify recurring member issues and bring forward practical solutions to improve the experience
• Work your assigned shift, including evenings, overnights, weekends, and holidays, as applicable

Desirable

• Maven is looking for a Senior 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
• 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, 8:30 a.m.–5:00 p.m
• Monday–Friday, 10:00 a.m.–6:30 p.m
• Monday–Friday, 1:00 p.m.–9:30 p.m
• Monday–Friday, 6:00 p.m.–2:30 a.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
• 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
• Reading what a member is actually asking for. A question about a denial and a formal appeal look alike and are handled differently. So do a denied application and 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