Client Services Representative I

Education Services

• Educate newly enrolled and existing plan participants on health plan and ancillary benefits at group’s work site locations, via phone or virtual platforms.
• Conduct group benefits presentations in both English and Spanish for WGAT and PCMI plan participants.
• Interface with third party vendors/providers to communicate and educate them on benefits and programs specific to WGAT plan participants.
• Provide one-on-one support to address applicant concerns or questions.
• Serve as the primary contact for questions regarding benefits utilization.

Member Services

• Aid in the enrollment of participants.
• Screen all enrollment paperwork for accuracy and completion.
• Work with Client Service Supervisor to organize assigned group service meetings and open enrollment for the most economical and effective use of time.
• Research and respond to WGAT and PCMI participant claim and administration questions utilizing the Health Care Processing system and the CTSR web-based tool(s).
• Determine necessary corrective action for problem/issue resolution using established documentation procedures and protocol.
• Request Benefits Information Booklet and Benefit Summaries/SBCs for health benefit information specific to each account.
• Support Regional Sales Manager/Account Manager/Broker/Client with plan comparisons, pre-filled enrollment/waiver forms, and any other materials or requests as needed.
• Attend employee client events to assist with benefits inquiries, provide materials to plan participants, and promote and enroll plan participants in value-added programs.

Data Collection

• Compile and track data pertaining to problems/issues, action taken and resolutions using the CTSR web-based tool.
• Document all services to include; enrollments, service meetings, employee client events, wellness events, courtesy calls and visits utilizing the CTSR web-based tool.
• Generate reports on metrics and suggest improvements to processes.

Other Duties

• Utilize all capabilities to satisfy one mission: To enhance the competitiveness and profitability of our members.
• Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
• Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 40% of the time.