What are the responsibilities and job description for the Client Resolution Specialist position at GuideWell?
Job Description
Get To Know Us!
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30 years of experience building unique benefit solutions and managing customized health plans.
What is your impact?
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 19100 Ridgewood Pkwy San Antonio, TX 78259
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.
Assisting with customer service phone calls and queues as assigned.
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
Provide instruction and training to Customer Service Team when directed by the employer group or the Customer Service Manager.
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
What We Can Offer YOU!
To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to :
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.
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.
About Us
At GuideWell, we are committed to making diversity, equity and inclusion part of everything we do. We believe in hiring people who represent the communities we serve while creating a workplace that encourages a sense of belonging for everyone, no matter who you are or where you come from.
From students to former military to seasoned professionals, our family of mission-based companies are stronger because of the unique talents and skills of our employees. We believe everyone's contribution has the power to help people and communities achieve better health. Find your new team today.
About the Team
We're proud to be named a Top Workplaces 2020 employer by The Dallas Morning News and the San Antonio Express-News for a second year in a row. We're even more proud of the hard work, passion and commitment that our amazing team of employees put in day after day in order to make this achievement happen. This is what makes WebTPA a family.
