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Organization TypePublic Interest
Years of Experience
ProfileSpecialist, Client Services Unit I Duties: Supports growth and retention of members in the region by: 1) Providing one-contact resolution to escalated employer and broker concerns that requires the application of considerable discretion and independent judgment to evaluate various courses of conduct, formulate solutions, and negotiate resolution that binds departs from prescribed standards 2) Analyzing patterns and trend data regarding employer and broker concerns and needs 3) Formulating recommendations to improve and sustain effective purchaser relationships. Identify growth and benefit expansion solutions to better meet purchaser health care needs. Report trends around issues groups are experiencing to inform on strategic account engagement and renewal planning. Identify, analyze and report trends and/or systematic issues as they become apparent. Provide consultation and recommendations to management around process improvement opportunities and solutions. Participate in policy formulation around service issue areas. Research and Resolution of Employer and Broker Initiated Issues: Formulate solution to complex and sensitive employer-initiated and broker-initiated concerns, using considerable discretion and independent judgment. Investigate circumstances surrounding purchaser issues and evaluating various courses of conduct. Negotiate reasonable and contractually defensible resolution of purchaser issues by weighing conflicting information (regulations, legal principles, and regional goals), departing from prescribed standards and binding. Log issues received and maintain updated status of resolution in the system of record. Ensure accurate and complete data is entered into the correct business applications, including eligibility data, CM, KPHC, Diamond and downstream systems. Identify deficiencies and make recommendations for improvement. Complete recommended training around health plan products and processes. Maintain understanding of group and member eligibility and Underwriting principals. Stay current on applicable laws and regulations. Pursue opportunities to continuously develop skills.
Qualification and Experience
Qualifications: High School Diploma or GED required. 2 years in an administrative role within health care, health insurance, paralegal, finance, customer service in an office setting, claims, legal, health care or Sales and marketing. Ability to communicate effectively and courteously with customers. Ability to apply judgment and make autonomous decisions to quickly resolve issues on behalf of client. Demonstrated expertise in dealing with difficult situations. Demonstrated strong organizational skills, problem solving, interpersonal skills, independence and initiative. Effective written and verbal communication skills. Proficiency in computer and analytic skills. Strong knowledge and experience in using multiple client databases and systems. Experience in customer service, enrollment, billing, claims processing, sales, account management or health plan administration in healthcare or health insurance industry. Background experience in brokerage/consultant, insurance carrier, TPA, or benefits administration. Knowledge of health plan information system technologies including but not limited to: CM, Tapestry, Diamond, Salesforce.com, Outlook, and Epic. Ability to analyze processes, identify and implement process improvements, and manage targeted implementations. Demonstrated understanding of current / future trends and changes in healthcare / health insurance laws / regulations. Demonstrated understanding of competitor’s strengths, weaknesses and strategies.
Job Number: 647657