Client Resolution Specialist

Guide Well • San Antonio, TX

84d

About The Position

The Client Resolution Specialist maintains responsibilities similar to a Customer Service Representative and is responsible for handling inbound customer calls from both providers and members but is more highly focused on resolving client-related issues and providing expert-level resolution to complex cases. The incumbent may have more interaction with Benefits departments in trying to solve complex issues.

Requirements

• 1+ years related work experience in customer service
• High school diploma or GED
• Knowledge of CPT and ICD-9 coding, COBRA, HIPAA, pre-existing conditions, and coordination of benefits
• Data entry and 10-key by touch/sight required
• Concise written and oral communication skills required, including the ability to deal with conflict
• Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers
• Knowledge of all MS Office products
• Must possess proven judgment, decision-making skills and the ability to analyze.

Nice To Haves

• Some college courses in related field
• Other experience in customer service for all types of medical claims would be helpful
• Proficiency and experience in WebTPA systems

Responsibilities

• Provide standard client support (60%): Primary client contact for claims and customer service issues and question for assigned accounts. Main customer service contact to resolve issues and identify customer needs on a pro-active basis.
• Utilize systems to track all assigned clients questions or concerns.
• Assisting with customer service phone calls and queues as assigned.
• Provide expert level of assistance to members who have complex or escalated issues that have not been successfully resolved by normal means (20%): Identify members who have high claim volumes or excessive calls to customer service, which may be an indication that they need help understanding their plan or help with finding solutions.
• Work directly with the Benefit Consultant for the employer group, to resolve claim or customer service issues.
• Other responsibilities include researching claim appeals, researching benefit questions, locating in-network providers (10%).
• Provide direction and training to client-dedicated Customer Service Team staff (5%): Provide instruction and training to Customer Service Team when directed by the employer group or the Customer Service Manager.
• Assisting with assigned special projects (5%).

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees