Client Resolution Specialist

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.

Essential Functions

• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• Provide standard client support:
  • Primary clients 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. (60%)
• 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. (20%)
• 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:
  • Provide instruction and training to Customer Service Team when directed by the employer group or the Customer Service Manager. (5%)
• Assisting with assigned special projects. (5%)

Required Work Experience

• 1+ years related work experience. Experience Details: Experience in customer service

Required Education

• High school diploma or GED

Required Qualifications

• 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

• Other experience in customer service for all types of medical claims would be helpful.
• Proficiency and experience in iii: PUT a plus.

Preferred Education

• Some college courses in related field

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.
• 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.