Client Resolution Specialist

Client Resolution Specialist

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

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.

In office at 6535 North State Highway 161, Irving, TX 75039

Ability to work between the hours of 7:00am - 7:00pm CST Monday to Friday

What Will You Be Doing:

• 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.

What We Can Offer YOU!

• 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

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

We are an Equal Employment Opportunity employer committed to cultivating a work experience 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.