Member Solutions Coordinator

Tokio Marine HCC • Birmingham, AL

1d • Hybrid

About The Position

Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Organic growth and over 60 successful acquisitions have grown our 2022 Gross Written Premium (GWP) to $5 Billion. Our workforce has grown to 4,300 worldwide … big, but not so big that you cannot make a difference. Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work. TMHCC Stop Loss, a $2 Billion division within TMHCC, leads the way in providing medical stop loss insurance sold to employers. Medical Stop Loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims, and Medical Stop Loss insurance from Tokio Marine HCC is designed to protect employers from that risk. This role is located onsite in Birmingham Alabama Position Summary: Under supervision, this position is responsible for assisting customers and providers in navigating insurance plans and coverage to facilitate the care pathway.

Requirements

• Minimum High School or GED
• Knowledge of quality measures and procedures
• Ability to support and represent a team's needs to other departments
• Possess and have ability to apply advanced knowledge of principles, practices, and procedures
• Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy
• Superior organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
• Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company’s business to proactively respond to changing business environment
• Overtime hours may be required to fulfill job responsibilities
• May be required to remain stationary for extended periods of time
• May be required to move up to 10 pounds
• Must be able to operate a computer and other devices
• Close vision and ability to adjust focus, such as required to read a computer screen

Responsibilities

• Strong sense of urgency handling a high-volume amount of inbound and occasionally outbound calls.
• Engage with customers and providers to verify insurance benefits and check claim status.
• Strong working knowledge of insurance coverages, EOB, UB04 Claim forms and 1500 forms.
• Verifies insurance and claim status in communicating regularly with doctors’ offices and insurance holders.
• Manages challenging customer service situations while maintaining a positive, empathetic, and consultative approach towards the customer during their time of need.
• Maintains working knowledge of insurance co-pays and deductible to ensure accurate and compliant billing information.
• Answers telephones, takes, and directs messages on a timely basis according to the direction and location appropriate to maintain continuous workflow.
• Maintains an organized and efficient work environment by keeping files and records neat and orderly to promote a smooth workflow and to ensure confidentiality.
• Must have excellent multitasking skills, with the ability to work on projects simultaneously.
• Adheres to all HIPPA policies.
• Provides assistance with call-backs and other projects as call volume permits.
• Handle a high volume of incoming claim status calls in a timely and professional manner.
• Manage and resolve a high volume of eligibility‑related calls.
• Monitor, process, and respond to a high volume of emails and faxes from multiple sources
• Follow up on all outgoing emails and faxes to ensure timely and accurate responses.
• Manage all voicemails and return calls promptly.
• Serve as the primary point of contact for member portal calls.
• Email or fax overpayment return forms to providers as required.
• Submit emails with all required information to request payment voids and reissues.
• Forward a high volume of claims to Audit for processing and reprocessing.
• Forward claims and correspondence to the Mailroom for scanning and documentation.
• Efficiently utilize multiple systems and data sources—including Quantum Choice (QC), Echo Health, Smart Data Solutions, and the LCS Data Warehouse—to research and resolve inquiries.

Benefits

• Generous paid time off (PTO)
• 12 paid company holidays
• 401(k) Retirement Plan with 6% company match
• Health and dental insurance, and vision plan available
• Company-provided long-term disability and life insurance
• Opportunities for advancement in a successful and growing organization
• Flexible work schedules and a great work/life balance
• Paid Parental Leave
• Volunteer Time Off
• Enjoy casual dress and work in a modern, comfortable office with free parking
• Hybrid work schedule

What This Job Offers

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