Senior Resolution Specialist

University Health System- San Antonio; San Antonio (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

Community First Insurance seeks a Member Services Specialist to resolve member inquiries, guide via the secure portal, and complete correspondence requests while ensuring HIPAA compliance.

You will educate members on benefits, navigate complaints and appeals, assist with non-covered services, and coordinate with other departments as needed.

Qualifications

• Bachelor’s degree in business, health care or related field.
• Minimum of 1 year’s experience in the managed care industry is required.
• Minimum of 4 years’ experience in health insurance or customer service; can substitute for education.
• Complaints and appeals resolution or quality improvement management experience is highly preferred.

Responsibilities

• Resolve member inquiries and use the secure member portal to respond and complete correspondence requests.
• Respond to members or regulatory agencies when appropriate and assist with navigating benefits and services.
• Support members in addressing non-covered services and accessing community resources.
• Participate in interdepartmental processes as needed and maintain HIPAA compliance.

Education

Bachelor’s degree in business, health care or related field

Job description

Demonstrates comprehensive knowledge of all Community First Insurance products including third party administrative services to resolve member inquiries. Use their knowledge to resolve member inquiries through the secure member portal, complete correspondence request and respond to members or regulatory agencies when appropriate. Assist members in navigating benefits, services, complaint and complaint appeals processes and provide education and support to access care and services. They may also assist members in accessing non-covered services, such as those provided in other social services or community programs. Additionally, they may be called upon to participate in other interdepartmental processes, as needed. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies about all aspects of operations within Member Services.

EDUCATION/EXPERIENCE

Bachelor’s degree in business, health care or related field with one year’s experience in the managed care industry is required. Minimum of four years’ experience in health insurance, or customer service industry, can be substituted for education. Complaints and appeals resolution or quality improvement management experience is highly preferred.