Client Resolution Specialist

Get To Know Us!

WebTPA, a Guide Well 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.

Location:

In office at 19100 Ridgewood Pkwy San Antonio, TX 78259 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.

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.