Healthcare Client Solutions 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

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.