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What you'll do:

• Problem Resolution & Analysis: Maintains a client problem resolution log and reviews it with Account Management, Claims, Plans and Member Services Teams on a weekly basis.
• Issue Escalation: Elevates plan discrepancies and/or client issues immediately to Management and the Account Executive.
• Trend Tracking: Tracks trends and issues to review with CX Leadership and the Account Executive.
• Internal Support: Assists Member Services and Claims Managers with workflow, problem-solving, and resolution of difficult customer inquiries.
• Communication: Prepares correspondence and reports in a clear and concise manner.
• Efficiency & Accuracy: Multi-tasks and meets deadlines while maintaining a high level of accuracy, quality, and overall service delivery.
• Team Collaboration: Actively participates with CX Managers to drive issue resolution, process improvement and root cause analysis and correction to avoid repeat issues.
• Claims Processing: Processes claim corrections on escalated issues, including overpayments, refunds, stop payments, adjustments, and check tracers in a timely manner.
• Meeting Participation: Attends and participates in Team and Departmental meetings. This includes client implementation meetings and client culture trainings, if applicable
• Account Management Support: Attends and supports the Account Management team on weekly client calls, QBRs, YiR or Client Site visits, as needed.
• Compliance: Abides by and supports all regulatory and compliance process, policies and procedures.

To be successful in this role, you'll need:

• 5+ years of progressive health insurance experience, including 3 years of relevant medical claims processing experience
• Demonstrated knowledge of healthcare industry and familiarity with health insurance terms
• Ability to prioritize client issues and concerns
• Strong problem-solving and analytical skills
• Excellent written and verbal communication skills, including de-escalation skills and remaining composed under pressure
• Ability to multitask and manage time effectively
• Attention to detail and high level of accuracy
• Strong understanding of federal and state health insurance regulations, including but not limited to ERISA, ACA, HIPAA, COBRA, and MHPAEA, as applicable

Pay Transparency Statement

This is a hybrid position based out of one of our offices: Plano, TX, or Lehi, UT. Hybrid employees are expected to be in the office three days per week (Plano, TX) or two days per week (Lehi, UT).#LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.