On-site Client Resolution Expert - Healthcare Claims

Florida Blue Group; San Antonio (TX); On-site; USD 36,000 - 54,000; Full time

Job summary

WebTPA, a GuideWell Company, in San Antonio, TX, is seeking an entry level Client Resolution Specialist. You will handle inbound calls from providers and members, resolve complex client issues, and partner with Benefits teams to find solutions.

This on-site role requires 7:00am–7:00pm CST, Monday–Friday, and a high school diploma with at least 1 year in customer service. You will use various systems and train other staff as needed, contributing to a collaborative team.

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.

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 track 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, and work with the Benefit Consultant for the employer group to resolve claim or customer service issues.
• Research claim appeals, research benefit questions, and locate network providers.
• Provide direction and training to client-dedicated Customer Service Team staff and training when directed by the employer group or the Customer Service Manager.
• Assisting with assigned special projects.

Skills

Customer service

Phone support

Communication

MS Office

Education

High school diploma or GED

Tools

CRM systems

Job description

WebTPA, a GuideWell Company, in San Antonio, TX, is seeking an entry level Client Resolution Specialist. You will handle inbound calls from providers and members, resolve complex client issues, and partner with Benefits teams to find solutions.

This on-site role requires 7:00am–7:00pm CST, Monday–Friday, and a high school diploma with at least 1 year in customer service. You will use various systems and train other staff as needed, contributing to a collaborative team.