Client Resolution Specialist

Overview

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The Client Resolution Specialist maintains responsibilities similar to a Customer Service Representative and handles inbound customer calls from both providers and members, with a stronger focus on resolving client-related issues and providing expert-level resolution to complex cases. The incumbent may have more interaction with Benefits departments in solving complex issues.

In office at either location:

• 6535 SH 161, Irving, Texas 75039

• Provide standard client support (60%):
  Primary client contact for claims and customer service issues for assigned accounts. Main customer service contact to resolve issues and identify customer needs on a proactive basis.
• Utilize systems to track all assigned client questions or concerns. Assist with customer service phone calls and queues as assigned.
• Provide expert level assistance to members with complex or escalated issues not resolved by normal means (20%):
  • Identify members with high claim volumes or excessive calls to customer service, indicating they may need help understanding their plan or 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 (10%).
• Provide direction and training to the client-dedicated Customer Service Team staff (5%):
  • Provide instruction and training to Customer Service Team when directed by the employer group or the Customer Service Manager.
• Assist with assigned special projects (5%).

• 1+ years related work experience in customer service
• High school diploma or GED
• Knowledge of CPT and ICD-9 coding, COBRA, HIPAA, pre-existing conditions, and coordination of benefits
• Data entry and 10-key by touch/sight required
• Concise written and oral communication skills, 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

• Some college courses in related field
• Other experience in customer service for all types of medical claims would be helpful. Proficiency and experience in WebTPA systems

Sedentary work:
Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

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.

• Entry level

• Full-time

• Other

• Insurance

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