Client Care Specialist

Global Excel Management

  • Miami, FL
  • Permanent
  • Full-time
  • 14 days ago
Job Description:Hybrid role- Requires going to the Miami officeJob Purpose:The position exists to ensure that Corporate Client request are overseen, responded to in a timely
manner, while either acting as a liaison between the client and operational teams or performing the
coordination of services necessary to meet the clients’ needs.The Client Care Specialist are part of the Claims Services team and will work closely with the Claims
and Account Management teams as well as with other departments and outside vendors with the
goal of obtaining information required by clients or needed as part of our internal processes.
Expected Outcomes and Actions1- Client Care Management (50%)
  • Ensure client requests are handled effectively, efficiently and that activities are coordinated with
operational teams, providers, suppliers, or other various sources as required to meet the client’s
needs
  • Update and ensure accuracy of documentation, contacts, benefits and eligibility, member
information, and all other relevant claim information gathered throughout the claims process
  • Review and assess activities needed in each claim to take appropriate actions, to successfully
manage and oversee work assignments e.g. making inbound and outbound calls, emails, and
faxes (as applicable)
  • From providers; obtain bills, medical records, itemized statements, statement of accounts,
request refunds/reimbursements, etc. and other information that may be required by the client
or internally to finalize the processing of a bill.
  • Minor Provider escalation
  • Solve balance billing issues, confirm network participation, dispute, etc. Escalate accordingly
  • Coordination of medical appointments
  • Proving insurance information (front and back end)- Placing VOB, updating client, etc.
  • Contacting providers for information required to finalize a bill; wire transfer details, missing
information on bills, etc. (domestic and international providers)
  • Account reviews and reconciliations – gathering statements from providers to review balances
and outstanding payments on accounts.
  • Develop strong working relationships with operational teams and Account Management while
sharing feedback, knowledge, or opportunities when applicable
  • Answering bill queries
  • Payment status
  • Provide high level of customer service
2- Tools and resources (45%)
  • Triage and validate incoming communications/documents from Corporate Clients, or other
various sources, as related to new claim openings or existing claim updates while ensuring
document integrity and meeting both internal and external service level targets
  • Create new policies and claims within the claims system while performing policy validation.
  • Ensure appropriate system workflows, task remarks and outcomes, contacts, communications,
and documents have been created accurately within the claims system.
  • Read and interpret information in our various systems and be able to provide accurate and
complete responses to corporate clients, suppliers, providers, or other various sources
  • Obtain and share information, documents, benefits, or approvals needed by the client, internal
contacts, providers, or suppliers to support the claim
  • Resolve minor escalations or complaints in a timely fashion and escalate to Account Management
or proper area when appropriate for further action. Assist with the gathering of information
required to respond to escalations
  • Complete additional tasks as assigned by leader
  • Assist with Reworks, Payment Criteria, Client Specific activities data Entry
  • Gotrex Task management and Gotrex communications. Update corporate client on requests.
  • Serve as Subject Matter Expert for internal queries and support other areas of the organization as
needed.
  • Work closely with Claims Team and understand claims process and adjudication
  • Assist with other activities as needed by the business and assist with funding and collection
initiatives
  • Complete additional task as assigned by leader
3- Continuous learning (5%)
  • Become familiar with various international healthcare markets as well as Account Management,
Sales, and Operational responsibilities
  • Engage in learning opportunities that arise within the department or Global Excel as related to
systems, processes, industry awareness, or as related to general development objectivesSuccess Measures
  • Client Care Management:
o Attain quality and accuracy and performance targets
o Effective time and workload management while maintaining expected levels of productivity
o Attain both internal and external Service Level targets as defined
  • Tools and Resources
o Quality and level of accuracy as demonstrated in Technical Audits
o GDPR, HIPPA, PIPEDA and other regulatory compliance
o Timeliness of task completion
  • Continuous Learning
o Participation in learning activities and demonstrating application of knowledge attainedMajor Accountabilities
  • Oversee claim related activities and resolution while providing expected level of Customer
Experience
  • Provide relevant and timely updates both internally and externally
  • Provide quality of service as related to role specific activities
  • Proper and timely escalation of complex cases, process breakdowns, client complaints, or efficiency
enhancement opportunitiesMajor Challenges
  • Complexities related to managing cases in multiple markets with unique and distinct client
requirements and expectations
  • Navigation of medical provider requirements and service delivery internationally
  • Understanding the complexities of internal operations processes
  • Level of autonomy required in decision making in a fast-paced environment
KSA (Knowledge, Skills and Abilities)
  • Knowledge of healthcare services and medical billing practices
  • Comfort with Microsoft suite of products and adaptable to different tools and technologies
  • Principles and application of excellent customer experience skills
  • Ability to work independently, organize, prioritize, and multitask
  • Resourcefulness and critical decision-making skills
  • Excellent interpersonal skills and professional written and spoken communication (and Spanish as
needed)Requirements and Qualifications
  • High school or Post-Secondary Education or equivalent
  • Minimum of two years of work experience in customer service and industry
  • Excellent verbal and written communication skills in English and Spanish

Global Excel Management