Client Resolution Specialist

WebTPA•San Antonio, TX

1d•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 question for assigned accounts.
Main customer service contact to resolve issues and identify customer needs on a pro-active basis.
Utilize systems to tract 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.
Other responsibilities include 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.