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WebTPA · 4 months ago

Client Resolution Specialist

Irving, TX, United States

Full-time

Onsite

Entry Level

1+ years exp

WebTPA, a GuideWell Company, is a healthcare third-party benefit administrator with over 30 years of experience. They are seeking a Client Resolution Specialist who will handle inbound customer calls, focus on resolving client-related issues, and provide expert-level assistance for complex cases.

Financial ServicesHealth Care

Growth Opportunities

Responsibilities

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 tract 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, locating in-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

Qualification

Customer service experienceCPTICD-9 codingHIPAA knowledgeMS Office proficiencyConcise communication skillsRapport buildingDecision-making skillsConflict resolution