Client Care Specialist

Hybrid role - Requires going to the Miami office

Job Purpose :

The position exists to oversee Corporate Client requests, respond in a timely manner, and act as a liaison between the client and operational teams or coordinate services to meet client needs.

Responsibilities :

• Client Care Management (50%)
• Handle client requests effectively, coordinate activities with operational teams, providers, and suppliers.
• Maintain accurate documentation of claims, benefits, member information, and client communications.
• Review and assess activities for each claim, including communication with providers and managing billing and reimbursement requests.
• Escalate provider issues and coordinate medical appointments.
• Provide insurance information, contact providers for bill finalization, and perform account reviews and reconciliations.
• Develop relationships with internal teams and share feedback.
• Respond to bill queries and payment status inquiries, ensuring high customer service levels.
• Tools and Resources (45%)
• Validate incoming communications and documents, ensuring integrity and meeting service targets.
• Create and validate claims and policies within the system.
• Interpret system information and respond accurately to clients and providers.
• Resolve minor escalations, assist with data entry, and support internal queries.
• Work closely with Claims Team to understand the claims process and support funding and collection activities.
• Continuous Learning (5%)
• Familiarize with international healthcare markets and internal responsibilities.
• Engage in learning opportunities related to systems, processes, and industry awareness.

Success Measures :

Major Accountabilities :

Major Challenges :

KSA (Knowledge, Skills, Abilities) :

Requirements and Qualifications :

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