Resolution Representative Job Description
Resolution Representative Duties & Responsibilities
To write an effective resolution representative job description, begin by listing detailed duties, responsibilities and expectations. We have included resolution representative job description templates that you can modify and use.
Sample responsibilities for this position include:
Resolution Representative Qualifications
Qualifications for a job description may include education, certification, and experience.
Education for Resolution Representative
Typically a job would require a certain level of education.
Employers hiring for the resolution representative job most commonly would prefer for their future employee to have a relevant degree such as Collage and Bachelor's Degree in Health Care, Education, Business/Administration, Accounting, Business, Associates, Counseling, Medical, Health Insurance, Communication
Skills for Resolution Representative
Desired skills for resolution representative include:
Desired experience for resolution representative includes:
Resolution Representative Examples
Resolution Representative Job Description
- Work Authorizations, Decline Calls, Urgent Logs, ACD Line, and Credit Applications
- Act as a liaison with Credit providers, banks, loss prevention, A/R, sales department and customers to resolve credit and billing issues
- Achieve established standards as defined by area
- Answer inbound calls and assist customers in various capacities
- Attend team meetings to keep updated on account requirements
- Use AS400 system (Sunrise), Remedy, and MS suite applications
- Utilize Internet Web sites, Web score, SORT, and SPOT to get vendor information, EDI transmission status, shipping information including bill of ladings, tracking numbers, and proof of deliveries
- Research and reply to all inquiries in a timely fashion that meet department set service levels
- Utilize required third party support for those inquires that cannot be resolved directly by the XHD resolution team
- Work directly with Wholesale Vendors to request returns, POD’s, shipping information, and miscellaneous reports
- Directly responsible for ensuring service levels in outbound mail processes
- Correlate outgoing cover letters with necessary enclosures in response to customer inquiries
- Monitor and provide feedback on queues to ensure compliance of cycle time requirements
- Responsible for meeting all Resolution Services objectives including service standards, productivity guidelines, expenses, and portfolio control
- Responsible for increased efficiency, productivity and quality
- Balance team and service level responsibilities with assigned projects
Resolution Representative Job Description
- Interacts with facilities to resolve accountsOther duties as assigned by Management
- Handle inbound phone calls to resolve escalated customer account issues
- Make adjustments to and notate customer accounts
- Research cardholder accounts
- Read help systems, daily bulletins and emails to stay current on policies and procedures
- Accepts and processes both written and phone notifications
- Contributes to process and customer experience improvements
- Monitor, research, and respond to all complaints received through the CFPB or BBB portals, federal/state agency e-mails, various internal channels, in a timely manner
- Track complaints received actions taken to resolve
- Report system-related issues policies and processes that may be the root cause of particular types of complaints
- Good Listening and Understanding skills
- Fluent in both English and French communication
- Work directly with patients, attorneys, government agencies, consumer protection groups, facilities (Admitting Manager, Director of Patient Services, Hospital Compliance Officer, Risk Manager, HIM Director, ), PFS Client Services Directors, Compliance, Security, Operations, Tenet Executive offices, and credit reporting agencies (CRAs) to resolve and respond to disputed issues in writing
- Analyze each specific dispute to determine what the resolution of such dispute should be
- Demonstrates a proficient understanding and use of the basic policy/contract coverages and is able to recognize questionable coverage/contract situations which necessitate supervisory involvement
- Must have excellent listening, written and oral communication skills
Resolution Representative Job Description
- Obtains information and maintains accurate records about accidents and injuries from customers and claimants through telephone and written reports
- Secures essential facts about accidents, assesses liability/compensability, negotiates settlements and explains denials to policyholders and claimants
- Review fraud cases to investigate potential fraud losses on accounts
- Help our customers resolve their concerns associated with suspected unauthorized activity on accounts
- Work directly with customers and merchants to investigate and determine the final outcome of fraud cases the financial responsibility associated with the transactions in question
- Conduct investigations to determine validity of transactions
- Verify account activity and customer activity
- Investigation and resolution of disputes ensuring compliance with all applicable federal and state laws and regulations, compliance to all Tenet policies, procedures, and reporting requirements
- Obtain consumer data (name and address) and conduct searches in various databases
- Knowledgeable in call routing and case management processes case logging
- Good oral and telephone communication skills typing skills required
- Basic accounting knowledge and billing concepts
- Time management and self-drive are essential to this role
- Must be able to work a M-F, flex schedule
- Performs various collection actions including
- Maintains tracking system of correspondence and outcomes of request
Resolution Representative Job Description
- Participate in monthly customer audit meetings to review, investigate and resolve issues
- Perform dispute for misrouted reinvestigation functions
- Proficient in ACIS and ACRO databases
- Able to read online consumer credit files
- Assist with testing as needed to ensure applications are performing as required
- Assist other teams as needed to ensure we are meeting compliance targets
- Conducts investigation to develop subrogation prospects
- Communicates effectively and openly with both internal and external functional groups
- Enters miscellaneous vendor credits and MCBs, based on paperwork submitted by the Purchasing, Claims, Supermarket, Business Analysis and Sales Departments
- Willing to learn and read online combines
- Use of web based applications
- Customer Value Creation – Asks questions and seeks information to gain a foundational understanding of how customers
- Years call center customer service or collection experience
- Able to decipher customer meaning
- MUST BE HIGHLY PROFESSIONAL, COURTEOUS AND SELF-MOTIVATED CUSTOMER SERVICE ORIENTATED WITH THE ABILITY TO DEFUSE DIFFICULT SITUATIONS
- Must be innovative, creative and flexible
Resolution Representative Job Description
- Provides general information regarding the order and billing related issues in a professional manner documenting all interactions in the system
- Processes orders in the Waiting for Payment queue that are over a specified dollar amount by researching payment history, payment options, patient assistance plan membership and outstanding balance orders
- Responds to incoming correspondence and ensures its proper documentation
- Verifies patient assistance benefits with vendor and handles internal paperwork to bill appropriate patient assistance plan
- Coordinates change of benefits when patient has utilized the maximum allowable amount of assistance
- Coordinates and recovers less complex subrogation cases under close team manager supervision
- Under close supervision, may negotiate settlements with responsible parties, their carriers or legal counsel
- Provides administrative support to the Credit department
- Assists with the daily credit functions, including account file maintenance, correspondence, phone inquiries and light collection calls
- Prepares various correspondence letters to customers
- Proficient with e-OSCAR Web based program
- Detailed-oriented and able to effectively handle multiple tasks at one time
- Abiltiy to make sound decisions
- Must have excellent listening, written and oral communication skills (proficiency in Spanish)
- Previous experience working in a similar complaint resolution role
- Strong problem solving and customer service skills/experience