Remote US
Position Summary:
As a Client Relations Specialist, you will be a vital member of our team, dedicated to providing exceptional customer service to our clients. You'll be the first point of contact for inquiries, resolving issues related to claims, eligibility, and benefits. Your role involves thorough investigation, accurate documentation, and effective problem-solving to ensure client satisfaction. You will collaborate with various departments, including Claims, Eligibility, and PBM/Rx, to identify root causes and deliver timely solutions. Your ability to manage inquiries efficiently and escalate complex issues appropriately will be essential to our team's success.
Position Responsibilities:
- Issue Resolution: Investigate and resolve client inquiries related to claims (medical, dental, flex, etc.), eligibility, ID cards, Rx, PBM, and benefits, performing root cause analysis to provide effective solutions.
- Escalation Management: Manage internal and external escalated questions and issues from brokers/consultants, clients, and members, aiming for a 24-hour turnaround time.
- Account Management Support: Provide proactive support to Account Managers, assisting with client inquiries and ensuring smooth communication.
- Reporting & Communication: Generate and deliver timely reports to clients and brokers as requested.
- Issue Tracking & Resolution: Coordinate the resolution of open issues from incoming calls and voicemails, utilizing issue logs and follow-up procedures.
- Team Collaboration & Training: Participate in weekly staff meetings and monthly training sessions to enhance skills and stay informed.
- Client Support: Fulfill miscellaneous duties as requested by Account Managers, directly related to client support.
- Web Portal Management: Create and maintain employer web portals using HealthX.
- Additional Responsibilities: Perform other duties as assigned.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Position Qualifications:
Required
- High School Diploma or equivalent
- Minimum of 2 years' experience in customer service or claims processing
- Minimum typing speed of 30-35 words per minute
- Knowledge of the health care industry, self-funding, and claims payment processes
Preferred
- Relevant professional certification
- Knowledge of medical terminology, CPT-4 coding, ICD-9/ ICD-10 coding
Skills, Knowledge and Abilities
- Customer Focus: Exceptional interpersonal and customer service skills
- Problem-Solving: Strong analytical and problem-solving skills, with the ability to identify root causes and implement solutions
- Teamwork: Ability to work collaboratively with internal and external stakeholders
- Healthcare Knowledge: Understanding of MedCost network, MBS claims processing policies and procedures, and medical/dental terminology and coding
- Technical Proficiency: Expertise in MedNet, claims adjudication (claims, eligibility, reports, check processing), HealthX, and Flex system applications
- Positive Attitude: Positive and cooperative work attitude
- Adaptability: Ability to function effectively at both tactical and strategic levels
- Communication: Excellent, both written and verbal
Key Competencies:
- Service orientation
- Integrity
- Ethical practice and confidentiality
MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants
