Client Resolution Specialist

4 weeks ago

Irving, United States Florida Blue Full time

Job Summary:
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. The incumbent may have more interaction with Benefits departments in trying to solve complex issues.

Location:

In office 8500 Freeport Pkwy Irving, Texas 75063

Essential Functions:
The essential functions listed represent the major duties of this role, additional duties may be assigned.

  • Provide standard client support (60%):
    • 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 (20%):
    • 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. (10%)
  • Provide direction and training to 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.
  • Assisting with assigned special projects. (5%)


Qualifications
1+ years related work experience in customer service
High school diploma or GED
Knowledge of CPT and ICD-9 coding required.
Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required.
Data entry and 10-key by touch/sight required.
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.
Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees.
Must possess proven judgment, decision-making skills and the ability to analyze.
Must learn quickly as well as be able to multi-task.
Must be motivated as well as possess a sound work ethic.

Preferred Qualifications:
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

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 Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

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