Florida Blue · 15 hours ago
Member and Client Resolution Specialist - San Antonio
San Antonio, TX, United States
Full-time
Onsite
Entry Level
1+ years expWebTPA, 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. The Client Resolution Specialist is responsible for handling inbound customer calls from both providers and members, focusing on resolving client-related issues and providing expert-level resolution to complex cases.
ConsultingHealth CareInsurance
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 track 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, and 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
Required
1+ years related work experience in customer service
High school diploma or GED
Knowledge of CPT and ICD-10 coding, COBRA, HIPAA, pre-existing conditions, and coordination of benefits a plus
Strong written and oral communication skills required
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, ability to analyze, including the ability to deal with conflict
Benefits
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
Company
Florida Blue
Florida Blue is a subsidiary of a not-for-profit health solutions company dedicated to serving all Floridians in the pursuit of health.
5001-10000 employees
H1B Sponsorship
Florida Blue has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (33)
2024 (27)
2023 (33)
2022 (20)
2021 (38)
2020 (56)
Funding
Current Stage
Late StageLeadership Team
Patrick Geraghty
President and CEO
Recent News
2025-11-04
Company data provided by crunchbase