Employer Service Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the main point of contact for designated employer groups regarding benefits administration and service inquiries.

• Address requests from employers, brokers, and members through phone, email, and ticketing systems while adhering to established service standards.

• Provide education to employer groups on TPA processes, policies, eligibility criteria, and available services.

• Foster and maintain positive relationships with clients and brokers.

• Collaborate with claims, provider relations, and stop-loss departments to address escalated issues.

• Investigate claim status inquiries and ensure timely resolutions.

• Track and record service issues to guarantee follow-through and client satisfaction.

• Uphold confidentiality and comply with HIPAA and company policies.

• Accurately document client interactions and account activities in internal systems.

• Assist with audit requests and reporting requirements as necessary.

• Engage in employer implementations and renewals.

• Recognize opportunities for process enhancement and improved client experiences.

• Contribute to special projects and cross-functional initiatives as assigned.

⛳️ Requirements

• High school diploma or equivalent is mandatory; an associate or bachelor's degree is preferred.

• A minimum of 2 years of customer service or account management experience in healthcare, insurance, benefits administration, or TPA operations.

• Experience in a self-funded health plan or TPA environment is a plus.

• Familiarity with ERISA, COBRA, HIPAA, and ACA regulations is preferred.

• Background in working with brokers, employer groups, and carrier partners.

• Working knowledge of group health benefits, eligibility, claims processing, and billing practices.

• Proficient in Microsoft Office Suite and capable of learning various administrative systems.

• Strong attention to detail and excellent organizational skills.

• Effective and confident communication skills for interactions with both internal and external customers.

🏝️ Benefits

• Comprehensive medical, dental, vision, and life insurance coverage.

• 401(k) retirement plan with employer match.

• Health Savings Account (HSA) and Flexible Spending Accounts (FSAs).

• Paid time off (PTO) and disability leave.

• Employee Assistance Program (EAP).