Employee Benefits Customer Service Representative

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Manage the resolution of claims, inquiries about benefits, concerns regarding coverage eligibility, and related issues for clients' administrators and employees.

• Collaborate with clients and carriers through phone and email to address matters within a 24-hour period.

• Respond to employee inquiries regarding insurance and benefit-related questions.

• Support claims resolution, advocate for patients, and handle pre-certifications.

• Educate client employees on how to effectively utilize benefits and explore cost-efficient plan options.

• Keep comprehensive records of client interactions in Salesforce and create analysis reports as required.

• Utilize Salesforce to collect client information and improve the quality of service.

• Track resolution timelines to ensure the closure of benefit issues and claims within specified timeframes.

• Review Summary Plan Descriptions and benefit summaries to ensure accuracy.

• Offer expertise in insurance billing, coding, employee group benefits, insurance processes, and plan descriptions.

• Act as a primary resource for the team in customer service and the resolution of insurance/benefit issues.

• Address inquiries regarding member eligibility, enrollment entries, and confirmation of coverage.

⛳️ Requirements

• A minimum of three years of experience in a customer service or call center setting.

• Experience with an insurance industry carrier, broker, or a related insurance vendor.

• Familiarity with eligibility claims, medical coding, and billing.

• Understanding of benefit summaries and Benefit Plan Descriptions.

• Excellent verbal and written communication skills.

• Strong organizational skills and ability to manage multiple tasks effectively.

• Proficient problem-solving abilities.

• Capable of taking initiative, prioritizing tasks, and meeting tight deadlines.

• Proficiency in Spanish (both written and spoken) is an advantage.

• A collaborative team player.

• Flexible and detail-oriented.

• Skilled in Microsoft Office Suite.

🏝️ Benefits

• Options for medical, vision, and dental benefits.

• 401(k) plan with company matching.

• Company-paid life insurance.

• Short-term disability (STD) coverage.

• Long-term disability (LTD) coverage.

• Paid time off (PTO) policy beginning at 18 days per year.

• Ten paid holidays.

• Two floating holidays.