Client Resolution Specialist

GuideWell; San Antonio (TX); Hybrid; USD 38,000 - 52,000; Full time

Job summary

WebTPA, a GuideWell Company, in San Antonio, TX, seeks a Client Resolution Specialist to handle inbound calls from providers and members and resolve complex client issues on site.

In this role you will manage claims questions, appeals, and provider lookups, with collaboration from Benefits Consultants for employer groups. Hours are 7:00am–7:00pm CST, Monday–Friday, and 1+ year CS experience plus healthcare knowledge are required.

Qualifications

• 1+ years related work experience in customer service.
• High school diploma or GED.
• Healthcare industry knowledge including CPT and ICD-10 coding, COBRA, HIPAA, and coordination of benefits.
• Concise written and oral communication skills, including conflict resolution.
• Proficiency in MS Office and general computer skills.
• Must possess judgment, decision-making skills and analytical abilities.

Responsibilities

• Provide standard client support: Primary client contact for claims and customer service issues for assigned accounts.
• Utilize systems to track all assigned clients questions or concerns and assist with customer service phone calls.
• Provide expert level assistance to members with complex or escalated issues and collaborate with Benefits Consultant for employer groups.
• Research claims appeals, research benefit questions, and locate network providers.
• Provide direction and training to client-dedicated Customer Service Team staff.
• Assist with assigned special projects.

Skills

Customer service

Healthcare knowledge

Communication

Judgment & analysis

Education

High school diploma or GED

Tools

MS Office

Job description

• Locations San Antonio, TX, United States (On-site)

Job Description

Get To Know Us!

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.

What is your impact?
The Client Resolution Specialist is an entry level position that 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.

-In office at 19100 Ridgewood Pkwy San Antonio, TX 78259 required

-Ability to work between the hours of 7:00am - 7:00pm CST Monday to Friday

What Will You Be Doing:

• 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.

Qualifications

• 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.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.