Member Guide at Firefly Health

Watertown, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Mar, 26

Salary

28.0

Posted On

13 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Health Insurance Terminology, Customer Service, Claims Management, Problem-Solving, Communication Skills, Attention to Detail, Google Workspace, CRM Systems, Claims Portals, Empathy, Process Improvement, Technical Research, Data Analysis, Documentation, Operational Improvements

Industry

Hospitals and Health Care

Description

Firefly Health is building a revolutionary new type of comprehensive health "care and coverage,” powered by a relationship-driven care team, a trusted virtual and in-person clinical network, and our proprietary technology platform. Founded by experienced clinicians and technology leaders, Firefly Health is on a mission to deliver clinical and financial health through joyful, always there care. We are flipping the script on what it means to be a health plan and actually providing a true health benefit to members. We are intensely focused on optimizing the physical + mental + financial wellbeing of those who want (and deserve) something better than the status quo. If you are ready to roll up your sleeves and take on our audacious mission, we would love to hear from you. The Role The Member Guide Associate serves as Firefly Health's frontline, playing a critical role in supporting members through their healthcare journey and ensuring the smooth resolution of varying types of inquiries. This position requires an individual with strong attention to detail, a curious and action-oriented mindset, and the ability to take ownership of tasks from start to finish. You will be responsible for helping members understand Firefly's unique approach to healthcare, ensuring they feel supported in understanding their benefits, getting them to the right internal team and answers, and also investigating and resolving billing and claims inquiries all within established service level agreements (SLAs). This role demands a true subject matter expert who can pivot seamlessly between explaining plan designs to a member and digging into technical claims adjudication issues with providers. You will: Member & Provider Support Serve as the first point of contact for member and provider inquiries, delivering support with professionalism and empathy. Educate members on their benefits—including deductibles, copays, coinsurance, Firefly Care Keys, and plan rules—through clear verbal and written communication. Use Summary Plan Documents (SPDs) and internal knowledge base resources (Guru) to help members understand and maximize their Firefly health plan benefits. Claims Inquiry Management: Capture, document, and triage claims inquiries from members and providers within SLA. Research claim details in internal and TPA systems to address technical questions and identify root causes. Compare and analyze claims data to resolve disputes and coordinate solutions across internal teams. Product & Technology Operations Leverage trends in inbound inquiries to identify root causes and recommend process improvements to reduce volume and enhance workflows. Provide feedback to enhance internal systems, tools, and claims workflows. Customer Experience Excellence Deliver empathetic, thorough support—often during stressful moments in a member’s healthcare journey. Proactively follow up on open issues to ensure complete resolution and member satisfaction. Collaborate cross-functionally to ensure seamless handling of issues across teams. You’d be a good fit if: You have a minimum of 2 years of experience in health plans, benefits, claims management, or customer service—ideally in a startup or growth-stage environment. You can work weekend shifts You have strong fluency in health insurance terminology (accumulators, OOP max, deductible, PPO/HMO networks, etc.) and can explain these clearly. You are highly proficient with Google Workspace, CRM/ticketing systems, claims portals, Slack, IVR/telephony tools, and internal knowledge bases. You have excellent communication skills, both written and verbal, with the ability to convey complex information clearly. You’re a structured and meticulous problem-solver with strong attention to detail. You take initiative, follow through, and thrive in a fast-moving, ambiguous environment. You care deeply about delivering an exceptional member and provider experience with patience and compassion. It’d be nice if: You’ve worked with third-party administrators (TPAs) or in claims adjudication workflows. You have experience using Looker or similar analytics tools to dig into raw data. You have prior exposure to early-stage or rapidly scaling healthcare organizations. You enjoy optimizing processes, creating documentation, or contributing to operational improvements. The salary range for this position is $25 per hour to $28 per hour; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Firefly Health is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment. Our office is in Watertown, Massachusetts, but we’ve developed a robust remote working structure to give us more geographical flexibility while hiring for many positions. This role can be done largely remotely, there are several times a year when staff come together onsite for planning and team building. Firefly is an equal opportunity employer. We value diverse backgrounds and perspectives. We're committed to building and sustaining an inclusive workplace culture where individuals are treated with dignity and respect. All employment is decided on the basis of qualifications, merit, and business need. Firefly is an E-Verify employer.

Responsibilities

The Member Guide Associate supports members through their healthcare journey, addressing inquiries and ensuring smooth resolutions. Responsibilities include educating members on benefits, managing claims inquiries, and collaborating cross-functionally.