Customer & Client Resolution Specialist

WebTPA • Irving, TX

13h • Onsite

About The Position

The Client Resolution Specialist at WebTPA, a GuideWell Company, is responsible for handling inbound customer calls from both providers and members, with a primary focus on resolving client-related issues and providing expert-level resolution to complex cases. This role may involve partnering with Benefits departments to solve intricate problems. The specialist serves as the main client contact for claims and customer service issues for assigned accounts, proactively identifying customer needs, and assisting with customer service phone calls and queues. They also provide expert assistance to members with complex or escalated issues, identify members with high claim volumes or excessive calls to help them understand their plan or find solutions, and work directly with Benefit Consultants for employer groups to resolve issues. Other duties include researching claim appeals, benefit questions, and locating network providers, as well as providing direction and training to client-dedicated Customer Service Team staff and assisting with special projects.

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.
• 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.

Benefits

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Flexible schedules after training + future WAH options!
• 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
• Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees