Client Services Representative II

About the Role

The Client Service Representative II (CTSR) reports to the Supervisor of Client Services and is responsible for the enrollment, implementation, and education of Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc. (Pinnacle) health benefit plan participants. This role involves interfacing with third-party vendors related to employee health benefits, investigating problems/issues, evaluating results, and determining corrective actions using established procedures. The CTSR also provides mentoring and training to new hires and Level I Client Service Representatives and compiles data on problems, actions taken, and resolutions.

Responsibilities

• Team Development
  • Travel to field offices to observe and assess Client Service Representatives’ enrollment and service techniques, identifying trends and training needs.
  • Develop and deliver client service training for newly hired and current Client Service Representatives.
  • Assist the Supervisor of Client Service in developing departmental policies, procedures, and job aids.
  • Assist in developing standard operating procedures (SOPs) for the client service process.
  • Support career progression by helping team members set and achieve development goals.
• Education Services
  • Educate newly enrolled and existing plan participants on health plans and ancillary benefits at client work sites, via phone, or virtual platforms.
  • Conduct group benefits presentations in English and Spanish for WGAT and PCMI plan participants.
  • Interface with third-party vendors/providers to communicate and educate them on benefits specific to WGAT plan participants.
  • Act as a point of escalation for complex enrollment issues.
• Member Services
  • Assist with participant enrollment and screen all enrollment paperwork for accuracy and completion.
  • Liaise with the Client Service Supervisor to organize group service meetings and open enrollment efficiently.
  • Investigate and respond to WGAT and PCMI participant claims and administration questions using the WGAT Health Care Processing System and CTSR web-based tools.
  • Determine corrective actions for problem resolution using established documentation procedures.
  • Request Benefits Information Booklets and Summaries of Benefits and Coverages for health benefit information specific to each WGAT account.
  • Support Regional Sales Manager/Account Manager/Broker/Client with plan comparisons, pre-filled enrollment/waiver forms, and other materials or requests.
  • Attend employee client events to assist with benefits inquiries, provide materials, and promote/enroll participants in value-added programs.
• Data Collection
  • Compile and track data on problems, actions taken, and resolutions using the Client Service Representative web-based tool.
  • Document all services, including enrollments, service meetings, employee client events, wellness events, courtesy calls, and visits.
  • Track and analyze metrics, identifying trends and opportunities for improvement.
  • Provide feedback to leadership on challenges and recommendations for process enhancement.
  • Assist in developing strategies to optimize outreach and increase participation rates.
• Other Duties
  • Contribute to the mission of enhancing the competitiveness and profitability of members by being collaborative, curious, and results-driven.
  • Maintain a clean DMV record and travel to locations throughout the U.S. (primarily California and Arizona) up to 40% of the time.
  • Perform other duties as assigned.

Requirements

• Regular communication with others is required.
• Frequent travel to both indoor and outdoor areas with varying exposure and temperature conditions.
• Frequent operation of a motor vehicle and use of tools or controls.
• Ability to lift up to 50 lbs.
• Moderate noise level in the work environment.