Employee Benefits Customer Service Representative

Job Summary

Handles claims resolution, benefits inquiries, coverage eligibility concerns, and other related issues for our clients' administrators and employees. Works closely with clients and carriers via phone and email to resolve matters within a 24-hour timeframe.

Essential Functions

• Address client employee insurance concerns, answer benefit-related questions, and assist with claims resolution, patient advocacy, and pre-certifications.
• Educate client employees on optimal benefit utilization and provide guidance on cost-effective plan options.
• Maintain detailed records of client interactions, entering data into Salesforce and generating client analysis reports as necessary.
• Use Salesforce to gather client information and enhance service quality.
• Monitor resolution timelines to ensure benefit issues and claims are closed within the designated timeframe.
• Review Summary Plan Descriptions (SPDs) and benefit summaries for accuracy.
• Offer expertise on insurance billing, coding, employee group benefits, insurance processes, and plan descriptions to clients.
• Act as a primary resource within the team, delivering exceptional customer service and support in resolving insurance and benefit-related issues.
• Address member eligibility inquiries, enrollment entry and confirmation of coverage.

Competencies & Qualifications

• Exceptional verbal and written communication abilities.
• Outstanding organizational and multi-tasking capabilities.
• Strong problem-solving skills.
• Skilled at taking initiative, prioritizing tasks, and meeting tight deadlines.
• Proficiency in Spanish (both written and spoken) is a plus.
• Collaborative team member.
• Adaptable and detail-oriented.
• Proficient in Microsoft Office Suite.

Education & Experience

• Three plus years’ experience working in customer service/call center environment.
• Experience with an insurance industry carrier, broker, or insurance related vendor.
• Knowledge of eligibility claims, medical coding and billing, etc.
• Knowledge of benefit summaries and Benefit Plan Descriptions.