Customer Service Representative- TPA -Must be located in Pittsburgh or Surrounding Area

About Our Client

This organization operates within the health insurance and employee benefits sector, addressing the need for clear, accessible support for members navigating complex benefit options. The team provides service for a variety of benefits including health insurance, education, retirement, and life insurance, aiming to assist members in understanding and utilizing their benefits effectively.

About the Opportunity

The Customer Service Representative- TPA serves as the primary point of contact for members seeking assistance with their benefits. This role is essential in delivering clear, compassionate support and solving inquiries efficiently to enhance member satisfaction. The position contributes to the organization by ensuring accurate communication of benefit information and maintaining strong service standards.

Responsibilities

• Respond to incoming multi-channel communications, including phone calls and emails from active employees, students, and retirees regarding their corporate benefits
• Perform accurate operational reporting, system audits, and data validation as required by management
• Guide and assist members in understanding their complex healthcare plan selections, coverage tiers, and premium options
• Troubleshoot and resolve claims, billing, or eligibility problems promptly and thoroughly to optimize first-contact resolution and prevent repeat contacts
• Document all customer interactions, case histories, and escalations accurately and concisely within the internal database system
• Navigate and manage multiple software tools, database systems, and interactive windows simultaneously while maintaining conversational focus and responsiveness
• Conduct professional outbound follow-up calls to provide members with timely status updates or resolution details
• Stay continuously updated on shifting company policies, insurance guidelines, compliance regulations, and software platform updates
• Provide highly professional, clear, and empathetic customer service consistently to support diverse caller demographics

Requirements

• High school diploma or equivalent background required; an Associate or Bachelor's college degree is preferred
• Minimum of two (2) years of successful professional experience in a customer service, tier-1 helpdesk, or centralized call center environment
• Proficient alphanumeric typing speed, proper grammar, and professional business writing skills
• Ability to analyze case details and make independent, logical problem-solving decisions within established guidelines
• Foundational familiarity and operational knowledge of Microsoft Office applications, specifically Outlook and Excel
• Strong analytical reasoning, administrative organization, and detail-oriented mindset
• Rapid learning capacity to absorb, retain, and explain complex health plan terminology, medical coverage rules, and policy exclusions
• High intrinsic motivation, resilience, and operational flexibility to learn, adapt, and grow within a fast-evolving corporate ecosystem
• Flexible schedule availability to accommodate varying operational day, evening, and rotating seasonal shifts
• Strict regional requirement: Must be physically located full-time within a 90-mile radius of Pittsburgh, PA or Erie, PA to accommodate regional updates or logistics
• Legal requirement: Must possess or be fully eligible to obtain a valid Pennsylvania Act 34 Criminal Record Check clearance

Pay Range and Compensation Package

Target baseline wage rate: $19.10 to $20.70 USD per hour
Final base hourly schedules are assigned dynamically based on the final applicant's prior third-party administrator (TPA) environment knowledge, benefit tracking systems familiarity, and localized geographic factors
Eligible to participate in standard corporate perks, virtual onboarding modules, and comprehensive group insurance options shared during the initial screening process

Equal Opportunity Statement

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note: RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.