Member Experience Specialist

Get To Know Us! WebTPA, a GuideWell Company, is a healthcare third-party benefit administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. What is your impact? The Member Experience Specialist will work in conjunction with the Account Executive to seek to improve the member experience for their dedicated clients by engaging with members and HR Benefits leaders to identify and uncover needs and providing solutions to escalated issues. They should proactively identify potential issues ensuring the organization is consistently providing exceptional member service and overall client service. This function is hybrid and resides within the Account Management team including working cross functional as needed with claims, customer service, analytics, and clinical. The Member Experience Specialist goal is to drive high quality, cost effective results for plan members and sponsors, with the ultimate goal of being a good steward of the plan's health care spend. The MES role will participate in WebTPA's development program for new team members to the business and to WebTPA. MES roles will move throughout the operational structure of WebTPA, leading and trained in 1) customer service, 2) claims processing, 3) eligibility/EDI, 4) analytics,5) reporting,6) client relationship management etc. What Will You Be Doing: Relationship management: Responsible for designing member solutions for clients, engaging directly with internal operational departments and assisting client’s Human Resource’s team members. Design and execute proactive member issue escalation resolution strategies. Eligibility responsibility, managing and troubleshooting Client EDI files and ensure eligibility implementation is finalized by established dates. Serve members as concierge support (as needed): Initiate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers; Serve as the immediate escalation resource for customer service reps and claims examiners; Responsible for researching claims where applicable. Provide member service: Outbound proactive outreach to members, as determined by the escalation, Account Executive and at the direction of client’s HR Benefits leadership; Resolve member issue escalation routed through member calls or HR Benefits leadership; Triage and elevate member issues to the necessary department when appropriate; Engage with members to ensure previous issues have been resolved in a timely manner; Support members and providers to the best experience in addressing OON facility services, provider billing challenges; Maintain good rapport with physicians, healthcare facilities, clients, providers and internal and external stakeholders. Review and process insurance to verify medical necessities and coverage under policy guidelines. Utilize systems to track complaints and resolutions. Responsible for 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 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. Ability 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. What We Can Offer YOU! 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) includes employer contribution match Paid time off, volunteer time off, and 11 holidays Additional voluntary benefits options available 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. #J-18808-Ljbffr WebTPA