Client Resolution Specialist
Florida Blue•San Antonio, TX
•Onsite
About The Position
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. 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. This may include partnering with Benefits departments in trying to solve complex issues.
Requirements
- 1+ years related work experience in customer service
- High school diploma or GED
- Knowledge in the healthcare industry including CPT and ICD-10 coding, COBRA, HIPAA, pre-existing conditions, and coordination of benefits
- 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.
Responsibilities
- Provide standard client support: Primary client contact for claims and customer service issues and questions 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.
- 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.
- Researching claim appeals, researching benefit questions, and locating network providers.
- Provide direction and training to client-dedicated Customer Service Team staff.
- Provide instruction and training to Customer Service Team when directed by the employer group or the Customer Service Manager.
- Assisting with assigned special projects.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
