WebTPA · 2 months ago
Member Experience Specialist
USA
Full-time
Onsite
Entry Level
1+ years expWebTPA is a healthcare third-party administrator with over 30 years of experience in building unique benefit solutions. The Member Experience Specialist will enhance the member experience by engaging with clients and providing solutions to improve health and wellness through communication and proactive outreach.
Financial ServicesHealth Care
Responsibilities
Responsible for designing member solutions for clients, engaging directly with WebTPA POD and assisting client’s Human Resource’s team members
Design and execute proactive member engagement outreach strategies
Eligibility responsibility, managing and troubleshooting Client EDI files and ensure eligibility implementation is finalized by established dates
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 claims processing and adjudication, researching claims where applicable
Inbound and Outbound proactive outreach to members, as determined by the MES utilizing client data and analytics
Resolve member issues routed through member calls
Triage and escalate 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 (clinical edit logic)
Utilize systems to track complaints and resolutions
Responsible for basic POD reporting and analytics demonstrating POD level performance for clients
Qualification
Required
1+ years related work experience
Related Bachelor's degree or additional related equivalent work experience
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
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
One to three years' experience in the health insurance administration industry a plus
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
Company
WebTPA
WebTPA provides customizable administration solutions and products to employers, health systems and insurance companies.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2020-11-06Acquired
2001-05-01Series Unknown
Leadership Team
Tanner Vick
Chief Financial Officer
Recent News
2025-04-18
2025-01-17
2024-05-23
Company data provided by crunchbase