Member Experience Specialist

WebTPA, a Guide Well Company, is a healthcare third-party benefit administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

The Member Experience Specialist "MES" will work in conjunction with the Account Executive to seek to improve the member experience for their dedicated clients by engaging with members and HR Benefits leaders to identify and uncover needs and providing solutions to escalated issues. They should proactively identify potential issues ensuring the organization is consistently providing exceptional member service and overall client service.

This function resides within the Account Management team including working cross functional as needed with claims, customer service, analytics, and clinical. The Member Experience Specialist goal is to drive high-quality, cost-effective results for plan members and sponsors, with the ultimate goal of being a good steward of the plan's health care spend.

• This is an onsite role at 2929 Walker Ave NW, Walker, MI 49544

• Work hours M-F 8am to 5pm.

• Relationship management:
  Responsible for designing member solutions for clients, engaging directly with internal operational departments and assisting client’s Human Resource’s team members.

• Execute proactive member issue escalation resolution strategies.

• Eligibility responsibility in managing and troubleshooting Client EDI files.

• Serve members as concierge support:
  Serve as the immediate escalation resource for customer service reps and claims examiners, Responsible for researching claims where applicable.

• Provide member service:
  Outbound proactive outreach to members, as determined by the escalation, Account Executive and at the direction of client’s HR Benefits leadership Resolve member issue escalation routed through member calls or HR Benefits leadership Triage and elevate member issues to the necessary department when appropriate Engage with members to ensure previous issues have been resolved in a timely manner Support members and providers to the best experience in addressing OON facility services, provider billing challenges.

• Utilize systems to track complaints and resolutions.

• Responsible for basic reporting and analytics demonstrating service level performance for clients.

• 1+ years related work experience.

• Related Bachelor’s degree or additional related equivalent work experience from an accredited university; preferably in Business, communications or experience working the medical insurance field

• Strong proficiency with Microsoft Office.

• Strong verbal and written communication skills; ability to tailor communications based on audience and business objectives.

• Comfortable working and communicating at very high levels across operational areas and working in cross-functional teams

• Maintain confidentiality and observe HIPAA requirements

• Strong customer service skills.

• Ability to work independently/autonomously and proactively as well as collaboratively as a member of a team.

• Must thrive in a team environment; team success will be heavily emphasized.

• Must be a self-starter with the ability to identify problems/issues and offer workable solutions.

• Ability to prioritize or seek information on how to best prioritize projects.

• Project confidence, high energy, enthusiasm, and high regard for client advocacy and service

• One to three years’ experience in the health insurance administration industry a plus.

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

• Life insurance, Short- and long-term…