IBA Service Specialist. You will be part of our growing Customer and Client Service Department, serving as the voice of International Benefits Administrators through both written and verbal communications. The mission of this model is designed to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service allows maximization of inbound and outbound touchpoints to solve members' needs by taking ownership to resolve issues that arise by advocating on behalf of our members. You will also service our Providers by helping them coordinate care; answer benefit, claim & eligibility questions on behalf of our Members. IBA Service Specialist Responsibilities: * Taking inbound calls for both Members and Providers * Assisting to answer questions related to members' health plan. * Making outbound calls on behalf of our members to help resolve any billing issues or questions regarding their benefits. * Engages, consults and educates members/providers based upon their unique needs, preferences and understanding of International Benefit Administrators plans, using tools and resources to help guide them along a clear path to care. * Perform review of member claim history to ensure accurate tracking of benefit applied; including but not limited to maximums and/or coinsurance/deductible and uses applicable system tools and resources to resolve the member's needs. * Guide the member through their plan of benefits, International Benefit Administrators policy and procedures and other resources to comply with any regulatory guidelines. * Taking accountability to fully understand the member's needs by building a trusting and caring relationship with the member. Anticipates Customer needs. Provides the Customer with related information to answer the unasked questions with a First Call Resolution. * Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools. * Explains member's rights and responsibilities in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. * Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues. * Responds to requests received from International Benefit Administrators' litigation team; handles extensive file review requests. * Assists in preparation of complaint trend reports, compiling claim data for customer audits. * Reviews medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals; handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. If this sounds like you, please read on to see if your equipment, Internet, and peripherals meet the job requirements. We will provide all the computer equipment needed except the following. You will be supplied: 1 Laptop, 1 Monitor, 1 Headset & a Docking Station. Wi-Fi cannot be used. You will need an Ethernet cable connecting the modem to the computer to test the results for the internet speed. Must be a minimum of 25 mbps download speed and a minimum of 10 mbps for upload speed. To test, go to speedtest.net If you're ready to begin your career with IBA and meet the minimum requirements, then we can't wait to meet you. Apply now! Required Qualifications * 6 plus months in customer service role Preferred Qualifications * Strong written & verbal communication skills required * Ability to multi-task, prioritize and effectively adapt to a fast paced changing environment required * Demonstrated organizational and communication skills required * Intermediate typing skills - 50 WPM strongly desired * Ability to seamlessly, multi-task while using multiple systems, to efficiently provide service to members * Deep problem solving skills with demonstrated ownership of issue resolution * Possess top-notch people skills - listening, caring, connecting, empathy, and supporting * Highly perceptive individual with strong self-awareness and empathy in interacting with various audiences * Demonstrated propensity for responsiveness and a sense of urgency when helping members * Demonstrated ability to uphold IBA's values of caring, inspiration, integrity, and excellence in each member interaction and in building team cohesiveness * Strong skillset in the use of the suite of Microsoft Office tools strongly desired * Ability to work effectively in a team environment required * Ability to learn and retain in a complex environment * Health Background and Customer Service experience preferred * Bilingual a plus (Spanish, verbal and written) * Experience with Javelina a plus Education High School Diploma or G.E.D required - College degree or equivalent work experience strongly preferred Company Description International Benefits Administrators ("IB
International Benefits Administrators (“IBA”) is a TPA, founded in 1972, that specializes in the design, implementation & administration of self funded health and dental plans. IBA also provides claims paying support for several medical insurance carriers.