Demonstrates comprehensive knowledge of all Community First Insurance products including third party administrative services to resolve member inquiries. Use their knowledge to resolve member inquiries through the secure member portal, complete correspondence request and respond to members or regulatory agencies when appropriate. Assist members in navigating benefits, services, complaint and complaint appeals processes and provide education and support to access care and services. They may also assist members in accessing non-covered services, such as those provided in other social services or community programs. Additionally, they may be called upon to participate in other interdepartmental processes, as needed. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies about all aspects of operations within Member Services.
Bachelor’s degree in business, health care or related field with one year’s experience in the managed care industry is required. Minimum of four years’ experience in health insurance, or customer service industry, can be substituted for education. Complaints and appeals resolution or quality improvement management experience is highly preferred.
University Health is the only locally owned health system in San Antonio. For more than 100 years, University Health has been here to heal, improve health, train the next generation of medical professionals and ensure the people of San Antonio, Bexar County and South Texas have access to primary and advanced specialty care close to home.
Almost 11,000 employees and more than 1,200 physicians provide specialized services, including the region’s only Level I trauma center for both adults and children, and maternal and neonatal intensive care centers designated at the highest levels by the State of Texas.
As the region’s only academic health system, University Health is a hub of innovation and discovery, committed to delivering patient-centered, culturally competent, high-quality and compassionate care, based on a strong foundation of outcomes‐based research and innovative teaching.
Learn more at UniversityHealth.com. Follow us on Facebook, Instagram and X.
