Client Resolution Specialist

Job Details

In office at 19100 Ridgewood Pkwy San Antonio, TX 78259 required
Ability to work between the hours of 7:00am - 7:00pm CST Monday to Friday

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

What Will You Be Doing

• 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.
• 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.