Member Experience Specialist

About the role

The Member Experience Specialist works in conjunction with the Account Executive to enhance the member experience for dedicated clients. This role involves engaging with members and HR Benefits leaders to identify and address needs, escalating issues, and providing solutions.

Responsibilities

• Design and execute proactive member issue escalation resolution strategies.
• Manage and troubleshoot Client EDI files to ensure eligibility implementation is completed on time.
• Serve members as a concierge support, initiating claims investigations, negotiating settlements, interpreting medical records, responding to Department of Insurance complaints, and authorizing payments.
• Act as the immediate escalation resource for customer service reps and claims examiners.
• Research claims where applicable.
• Provide member service by outbound proactive outreach, resolving member issue escalations, triaging and escalating issues as needed, and ensuring previous issues are resolved promptly.
• Engage with members and providers to address out-of-network facility services and provider billing challenges.
• Maintain good rapport with physicians, healthcare facilities, clients, providers, and internal and external stakeholders.
• Review and process insurance to verify medical necessity and coverage under policy guidelines.
• Utilize systems to track complaints and resolutions.
• Contribute to basic reporting and analytics demonstrating service level performance for clients.

Qualifications

• 1+ years related work experience.
• Related Bachelor’s degree or additional related equivalent work experience from an accredited university; preferably in Business, communications, or experience working in the medical insurance field.
• Strong proficiency with Microsoft Office.
• Strong verbal and written communication skills; ability to tailor communications based on audience and business objectives.
• Comfortable working and communicating at very high levels across operational areas and working in cross-functional teams.
• Maintain confidentiality and observe HIPAA requirements.
• Strong customer service skills.
• Ability to work independently/autonomously and proactively as well as collaboratively as a member of a team.
• Must thrive in a team environment; team success will be heavily emphasized.
• Must be a self-starter with the ability to identify problems/issues and offer workable solutions.
• Able to prioritize or seek information on how to best prioritize projects.
• Project confidence, high energy, enthusiasm, and high regard for client advocacy and service.

Preferred Qualifications

• One to three years’ experience in the health insurance administration industry (a plus).

Benefits

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

• Medical, dental, vision, life, and global travel health insurance.
• Life insurance, short- and long-term disability programs.
• Leave programs to support personal circumstances.
• 401(k) including employer contribution match.
• Paid time off, volunteer time off, and 11 holidays.
• Additional voluntary benefits options available.
• A comprehensive wellness program.

What We Can Offer YOU!

WebTPA offers a supportive work environment where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.