Client Services Specialist

Description

The Client Services Specialist will proactively resolve difficult and complex client issues. This role will navigate across multiple databases and work cross functionally with internal departments to support the Account Management team or the client directly. The Client Services Specialist will initiate and implement corrective actions to ensure client needs are met at a high level of satisfaction.

Duties and Responsibilities:

• Utilize internal systems to receive and investigate escalated inquires on members and follow the member experience from beginning to resolution
• Demonstrate outstanding, proactive service to identify the source of the issue through all means necessary, including research and outbound calls. Work to resolve inquiries and issues related to benefits, eligibility, claims, spending accounts, financial impact, correspondence and others
• Conduct provider outreach which should result in account updates for the clients
• Work cross functionally with internal departments regarding client needs and requests, work procedures, gaps in policy, and other elements of supporting assigned clients and conduct member, provider and health plan telephonic education as needed
• Document each task administered; Perform data analysis to create rand document resolution paths
• Provide timely and professional service to internal/external Account Manager or directly to clients, ensuring follow-up and responses are conducted
• Carry-out daily review of all outstanding request and save all pending inquires to be actioned until complete
• Obtain and extract information from information systems such as proof of payment, explanation of benefits (EOB), out-of-pocket (OOP) spending, claims, pre-authorizations / pre-determinations, deductible spend and other types of information or reports
• Perform assigned system maintenance for various electronic files; escalate errors to assigned direct liaisons in Operations
• Participate and provide continuous improvement suggestions develop and recommend changes to existing methods and systems

Requirements

Required Knowledge, Skills and Abilities:

• High School diploma or equivalent; Associates degree or equivalent experience preferred
• 2 years of data management or advanced role in customer service in healthcare supporting Customer Service, Sales or Account Management; supervisor or team lead experience preferred
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook and PowerPoint
• Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
• Communicate clearly and professionally with internal and external customers
• Work effectively as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
• Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyzes information skillfully
• Share knowledge with associates by effectively communicating and providing follow-up. Open to other’s ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers.
• Work overtime as required, including weekends

Physical Demands - The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
• Occasional: Lift and/or move up to 10 pounds
• Constant: Regular, predictable attendance in the office is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.

Work Environment - The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.

The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.