Employee Benefits Customer Service Representative

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

📋 Description

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

• Collaborate with clients and carriers via phone and email to resolve issues within a 24-hour timeframe.

• Respond to employee inquiries regarding insurance and benefits.

• Assist in claims resolution, advocate for patients, and facilitate pre-certifications.

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

• Keep comprehensive records of client interactions in Salesforce.

• Create client analysis reports as necessary.

• Utilize Salesforce to collect client information and enhance service quality.

• Track resolution timelines to ensure that benefit matters and claims are resolved within specified periods.

• Review Summary Plan Descriptions and benefit summaries for accuracy.

• Offer guidance to clients regarding insurance billing, coding, employee group benefits, insurance procedures, and plan descriptions.

• Act as a key resource for the team on issues related to insurance and benefits.

• Handle inquiries regarding member eligibility, enrollment entries, and coverage confirmations.

⛳️ Requirements

• Minimum of three years of experience in a customer service or call center environment.

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

• Understanding of eligibility claims, medical coding, and billing practices.

• Familiarity with benefit summaries and Benefit Plan Descriptions.

• Excellent verbal and written communication skills.

• Exceptional organizational skills and the ability to multitask effectively.

• Strong problem-solving abilities.

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

• Proficiency in Spanish, both written and spoken, is a plus.

• A collaborative team player.

• Adaptable and detail-oriented.

• Proficient in Microsoft Office Suite.

🏝️ Benefits

• Options for medical, vision, and dental benefits.

• 401(k) plan with company matching contributions.

• Life insurance fully covered by the company.

• Short-term disability (STD) coverage.

• Long-term disability (LTD) coverage.

• Paid time off (PTO) starting at 18 days annually.

• 10 paid holidays each year.

• 2 floating holidays.