Member Experience Concierge & Solutions Advocate

WebTPA; Walker (MI); On-site; USD 42,000 - 66,000; Full time

Benefits offered by this job

Medical, dental, vision, life and全球旅行保

Life insurance

Short- and long-term disability

Paid time off

Volunteer time off

401(k) with employer match

Holidays (11)

Wellness program

Job summary

WebTPA, a GuideWell Company, seeks a Member Experience Specialist to partner with Account Executives and HR Benefits leaders to enhance member experiences and resolve escalations. You will engage with members and client HR teams, design member solutions, and manage EDI-related issues while maintaining HIPAA compliance and delivering concierge-level service.

The role sits in Account Management, with regular 8-to-5 onsite hours at the Walker, MI location, and requires strong communication,

Qualifications

• 1+ years related work experience.
• Bachelor’s degree or related equivalent work experience; preferably in Business, communications or medical insurance.
• Strong proficiency with Microsoft Office.
• Strong verbal and written communication skills; ability to tailor communications based on audience and business objectives.
• Comfortable working across cross-functional teams.
• Maintain confidentiality and observe HIPAA requirements.
• Strong customer service skills.
• Ability to work independently/autonomously and proactively as well as collaboratively as a member of a team.
• Must thrive in a team environment; team success will be heavily emphasized.
• Must be a self-starter with the ability to identify problems/issues and offer workable solutions.
• Ability to prioritize or seek information on how to best prioritize projects.
• Project confidence, high energy, enthusiasm, and high regard for client advocacy and service

Responsibilities

• Relationship management: Responsible for designing member solutions for clients, engaging directly with internal operational departments and assisting client’s Human Resource’s team members.
• Execute proactive member issue escalation resolution strategies.
• Eligibility responsibility in managing and troubleshooting Client EDI files.
• Serve members as concierge support: Serve as the immediate escalation resource for customer service reps and claims examiners, Responsible for researching claims where applicable.
• Provide member service: Outbound proactive outreach to members, as determined by the escalation, Account Executive and at the direction of client’s HR Benefits leadership Resolve member issue escalation routed through member calls or HR Benefits leadership Triage and elevate member issues to the necessary department when appropriate Engage with members to ensure previous issues have been resolved in a timely manner Support members and providers to the best experience in addressing OON facility services, provider billing challenges.
• Utilize systems to track complaints and resolutions.
• Responsible for basic reporting and analytics demonstrating service level performance for clients.

Skills

Communication skills

Team collaboration

Customer service

Confidentiality

Education

Bachelor’s degree in Business or related field

Tools

Microsoft Office

Job description

WebTPA, a GuideWell Company, seeks a Member Experience Specialist to partner with Account Executives and HR Benefits leaders to enhance member experiences and resolve escalations. You will engage with members and client HR teams, design member solutions, and manage EDI-related issues while maintaining HIPAA compliance and delivering concierge-level service.

The role sits in Account Management, with regular 8-to-5 onsite hours at the Walker, MI location, and requires strong communication,