Customer & Client Resolution Specialist at WebTPA

Irving, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

22 Jul, 26

Salary

0.0

Posted On

23 Apr, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer service, Claims resolution, Healthcare administration, CPT coding, ICD-10 coding, COBRA, HIPAA, Coordination of benefits, Conflict resolution, Communication skills, MS Office, Decision-making, Analytical skills, Training, Benefit consulting

Industry

Insurance

Description

Get To Know Us! 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. What is your impact? The Client Resolution Specialist maintains responsibilities similar to a Customer Service Representative and is responsible for handling inbound customer calls from both providers and members but is more highly focused on resolving client-related issues and providing expert-level resolution to complex cases. This may include partnering with Benefits departments in trying to solve complex issues. Job Details: -In office at 6535 SH 161 Irving Texas 75039 required What Will You Be Doing: * 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, 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! 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 * Income protection benefits: life insurance, Short- and long-term disability programs * Flexible schedules after training + future WAH options! * 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.

Responsibilities

The specialist acts as the primary contact for resolving complex claims and customer service issues for assigned accounts. They also provide expert-level support to members and offer guidance to the customer service team.