Benefits Customer Service Representative

Job Description

Handle a high volume of inbound phone calls and emails while maintaining a 90% or higher call answer rate.
Explain healthcare plan benefits and coverage.
Affiliate members in locating in-network physicians and healthcare facilities.
Educate members on self-service tools and available resources.
Make outbound calls to providers regarding eligibility and benefits.
Advocate on behalf of members with providers, pharmacies, and insurance carriers to resolve issues.
Respond to inquiries regarding: Flexible Spending Accounts (FSA), Commuter benefits, Ancillary benefits, COBRA and Medicare.
Troubleshoot debit card declines and online portal access issues.
Research eligibility and claims discrepancies and partner with internal teams to resolve them.
Support renewal activities by updating client/member contact information and benefit materials.
Verify member eligibility and claim payment information for healthcare providers.
Accurately document all member interactions.
Respond promptly to email inquiries and complete follow-up communications.
Escalate complex issues when appropriate.
Build and maintain strong relationships with members and clients.

Position Requirements

• High school diploma or equivalent.
• Strong customer service mindset with a professional and friendly demeanor.
• Excellent verbal and written communication skills.
• Strong interpersonal and problem-solving abilities.
• Ability to learn quickly and adapt to changing processes.
• Comfortable working in a fast-paced, high-volume environment.
• Reliable, organized, and able to manage multiple priorities.

Preferred Experience

• 6 months to 2+ years of customer service experience within employee benefits or healthcare.
• Two years of group benefits experience preferred.
• Knowledge of healthcare benefits and claims.
• Experience communicating benefit information to members.
• Proficiency with Microsoft Outlook, Word, Excel, and PowerPoint.