Service Resolution Specialist

Responsibilities: The Service Resolution Specialist handles second-level escalations regarding claims, eligibility, benefits, and billing. They investigate root causes, document findings in a tracker, and coordinate responses through Account Management.

Requirements: Requires a high school diploma or GED with at least 2 years of experience in health benefits customer service or claims. Proficiency with CRM systems like Zendesk and knowledge of benefit structures are essential.

Key skills: Claims Processing, Eligibility Management, Benefit Structures, CRM Proficiency, Zendesk, Written Communication, Verbal Communication, Issue Resolution, Root Cause Analysis, Medical Coding, Medical Billing, Customer Service

Keywords: Third-Party Administrator, TPA, Health Benefits, Claims Processing, Member Services, Zendesk, Medical Coding, Medical Billing, SLA, Root Cause Analysis, PBM, Health Plan, Customer Service, Escalation Management