Client Resolution Specialist

Overview

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 6535 SH 161 Irving Texas 75039

• Provide standard client support:
  Primary client contact for claims and customer service issues and questions 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, 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.

• 1+ years related work experience in customer service
• High school diploma or GED
• Knowledge of medical CPT and ICD-9 coding, COBRA, HIPAA, pre-existing conditions, and coordination of benefits a plus
• 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.