Bilingual Client Resolution Specialist

About the role

The Client Resolution Specialist is an early career position that will serve as a key resource for members, providers, clients, and internal teams by resolving complex service-related cases. This would include supporting Customer Service with both inbound and outbound calls and partnering with various departments for resolution.

Key job details

• In office at 6535 North State Highway 161, Irving, TX 75039
• Flexibility to work hours of 9:00am - 6:00pm CST Monday to Friday highly preferred
• Ability to meet training schedule of 8:00am - 4:30pm CST Monday to Friday
• Bilingual Spanish and English speaker highly preferred

Responsibilities

• Provide standard client support: Primary client contact for claims and customer service issues for assigned accounts and identify customer needs on a pro-active basis
• Track all assigned client questions and concerns
• Assist 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

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

Benefits

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan includes employer contribution and employer match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available and a comprehensive wellness program