Employee Benefits Customer Service Representative
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Job Description
Remote customer service representative resolving claims, eligibility, and benefits inquiries for Foundation Risk Partners, a US insurance brokerage and consulting firm. Supporting clients and employees through phone, email, and Salesforce.
Responsibilities:
- Handle claims resolution, benefits inquiries, coverage eligibility concerns, and related issues for client administrators and employees
- Work with clients and carriers by phone and email to resolve matters within 24 hours
- Address employee insurance concerns and benefit-related questions
- Assist with claims resolution, patient advocacy, and pre-certifications
- Educate employees on benefit utilization and cost-effective plan options
- Maintain detailed client interaction records in Salesforce
- Generate client analysis reports as needed
- Use Salesforce to gather client information and improve service quality
- Monitor resolution timelines and ensure benefit issues and claims are closed within designated timeframes
- Review Summary Plan Descriptions and benefit summaries for accuracy
- Advise clients on insurance billing, coding, employee group benefits, insurance processes, and plan descriptions
- Serve as a primary team resource for insurance and benefit-related issues
- Address member eligibility inquiries, enrollment entry, and coverage confirmation
Requirements:
- Three plus years’ experience working in a customer service/call center environment
- Experience with an insurance industry carrier, broker, or insurance-related vendor
- Knowledge of eligibility claims, medical coding, and billing
- Knowledge of benefit summaries and Benefit Plan Descriptions
- Exceptional verbal and written communication abilities
- Outstanding organizational and multitasking capabilities
- Strong problem-solving skills
- Skilled at taking initiative, prioritizing tasks, and meeting tight deadlines
- Proficiency in Spanish, written and spoken, is a plus
- Collaborative team member
- Adaptable and detail-oriented
- Proficient in Microsoft Office Suite
Benefits:
- Medical, vision, and dental benefit options
- 401(k) with company match
- Company-paid life insurance
- Short-term disability (STD)
- Long-term disability (LTD)
- PTO policy starting at 18 days per year
- 10 paid holidays
- 2 floating holidays
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