Benefits Resolution Specialist

Job Description

Complete corrections in response to mismatches identified.
Research and resolve root cause issues from Fulfillment/Quality Assurance Generalist (Tier 1 Staff).
Work with carriers on retroactive, exception, or standard requests related to member-level eligibility.
Maintain documentation per workflows, procedures, and protocols.
Provide feedback and guidance to business stakeholders based on audit/issue discoveries.
Serve as the single point of contact for the resolution lifecycle.
Ensure the protection and security of a consumer’s personal, confidential, and identifiable information in a professional and responsible manner, according to the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA).

Position Requirements

• Driven, self-motivated, and upbeat attitude.
• Strong team player and ability to collaborate across groups.
• Must be self-motivated and disciplined.
• Able to remain calm and clear-minded in a role that directly impacts both revenue and client satisfaction.
• Flexible approach, able to operate effectively with uncertainty and change.
• Knowledge of D365 and Excel.
• Excellent communication and interpersonal skills.
• Able to manage multiple assignments at one time.
• Able to thrive in a fast-paced environment.
• Must be able to handle high workload volume and meet demanding deadlines.
• A high level of accuracy and attention to detail is required.

Required Experience

• Current life and health insurance license, preferred.
• Minimum 2 years' cumulative experience.