Healthcare Service Specialist

7 days ago


Dallas, Texas, United States Southwestern Health Resources Full time

About the Role

As a Customer Experience Specialist I at Southwestern Health Resources, you will play a vital role in delivering exceptional service to our health plan members, prospective members, sales agents, and healthcare providers. Your primary responsibility will be to provide timely and accurate support via various communication channels, including telephonic, electronic, and in-person interactions.

Key Responsibilities

  • Provide exceptional customer service, addressing issues related to benefits and eligibility validation, claims status, billing, enrollment, provider search, PCP assignment, and appointment setting.
  • Assist with incoming enrollment facilitation, support health plan events, and respond to prior authorization status, pharmacy inquiries, provider disputes, appeals, and grievances.
  • Identify proper protocol routing, triage, and escalation as necessary, ensuring full accountability of follow-through and close-out.
  • Maintain personal metrics to established performance levels of the individual and team.
  • Engage in proactive telephonic outreach and customer interactions, including welcoming new members, customer retention, quality healthcare initiatives, PCP updates, and special projects.
  • Research and document complex issues across multiple databases, collaborating with support resources to resolve customer issues and escalate concerns as needed.

Why Southwestern Health Resources

As a valued member of our team, you will enjoy a comprehensive benefits package, including a 401(k) with match, paid time off, competitive health insurance choices, and opportunities for professional growth and development.

About Us

At Southwestern Health Resources, we are dedicated to delivering population-based healthcare that improves the lives of our patients and communities. Our team of over 850 employees uses data insights, clinical experience, and knowledge to deliver care to the right patient, at the right time, and in the right setting.

Our Mission

We strive to be the national leader in providing population-based healthcare by connecting physicians to patients and clinical insights to better outcomes. By lowering costs, optimizing value, and building a better healthcare system, we aim to make a positive impact on the lives of those we serve.



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