Client Resolution Specialist

Florida Blue • Irving, TX

1d • Onsite

About The Position

The Client Resolution Specialist is an early career position that will serve as a key resource for members, providers, clients, and internal teams by resolving complex service-related cases. This would include supporting Customer Service with both inbound and outbound calls and partnering with various departments for resolution.

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

• Primary client contact for claims and customer service issues for assigned accounts and identify customer needs on a pro-active basis.
• Track all assigned client questions and concerns.
• Assist 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.
• Research claim appeals, research benefit questions, and locate 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.

Benefits

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances.
• Retirement Savings Plan includes employer contribution and employer match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available and a comprehensive wellness program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED