On-site Healthcare Client Resolution Specialist

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

Job summary

WebTPA, a GuideWell Company, is seeking an entry-level Client Resolution Specialist to handle inbound calls from providers and members and resolve client-related issues, often coordinating with Benefits departments. In-office at 19100 Ridgewood Pkwy, San Antonio, TX 78259 is required.

Hours are 7:00am–7:00pm CST, Monday to Friday. The role involves serving as the primary client contact for claims and service issues, tracking inquiries, and assisting with escalated cases.

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 questions 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. 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.

Skills

Customer service experience

Healthcare industry knowledge

Written and oral communication

Professional rapport with physicians

MS Office proficiency

Judgment and analytical skills

Education

High school diploma or GED

Tools

MS Office

Job description

WebTPA, a GuideWell Company, is seeking an entry-level Client Resolution Specialist to handle inbound calls from providers and members and resolve client-related issues, often coordinating with Benefits departments. In-office at 19100 Ridgewood Pkwy, San Antonio, TX 78259 is required.

Hours are 7:00am–7:00pm CST, Monday to Friday. The role involves serving as the primary client contact for claims and service issues, tracking inquiries, and assisting with escalated cases.