Claims Customer Experience Specialist

FedPoint is a company that creates and operates digital benefits marketplaces for federal and military customers. They are seeking a Claims Customer Experience Specialist to analyze customer feedback, improve the claims service model, and enhance customer satisfaction for benefit-eligible clients. Responsibilities 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 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 Skills 1+ years of FLTCIP experience, or, 1+ years in long term insurance industry or comparable field such as experience with appeals, and/or complaints/customer satisfaction/customer experience management Strong understanding of FLTCIP products, regulations, and claims requirements Proficiency with Microsoft Office (especially PowerPoint and SharePoint) 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 Experience with AWD and CARE systems Benefits 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 benefits include health, dental, vision, disability, life, legal, flexible spending account (FSA) and Health Savings Account (HSA) options. 6 weeks fully-paid parental leave Tuition reimbursement program to support career goals. Corporate giving and matching gifts 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 program offering a variety of resources and activities to help support your well-being in the following areas: career, financial, mental, emotional, physical, social and community. Company Overview FedPoint is to build and administrate long-term care insurance programs for the federal family. It was founded in 2002, and is headquartered in Portsmouth, New Hampshire, USA, with a workforce of 201-500 employees. Its website is