Employer Service Representative

Primary Responsibilities

• Serve as a primary contact for assigned employer groups regarding benefits administration and service inquiries
• Respond to employer, broker, and member requests via phone, email, and ticketing systems within established service standards
• Educate employer groups on TPA processes, policies, eligibility rules, and available services
• Build and maintain positive working relationships with clients and brokers
• Cook up and maintain relationships with claims, provider relations, and stop-loss departments to resolve escalated issues
• Research claim status inquiries and facilitate timely resolutions
• Track and document service issues to ensure follow-through and client satisfaction
• Maintain confidentiality and ensure compliance with HIPAA and company policies
• Document client interactions and account activity accurately within internal systems
• Support audit requests and reporting needs as required
• Participate in employer implementations and renewals
• Identify opportunities for process improvement and enhanced client experience
• Support special projects and cross-functional initiatives as assigned

Qualifications

• A high school diploma or equivalent required; an associate or bachelor's degree preferred
• 2+ years of customer service or account management experience in healthcare, insurance, benefits administration, or TPA operations
• Experience in a self-funded health plan or TPA environment preferred
• Knowledge of ERISA, COBRA, HIPAA, and ACA requirements preferred
• Experience working with brokers, employer groups, and carrier partners
• Working knowledge of group health benefits, eligibility, claims processing, and billing practices
• Proficiency in Microsoft Office Suite and ability to learn multiple administrative systems
• Strong attention to detail and organizational skills
• Clear and confident communication skills for both internal and external customers

Pay

$50,000 - $55,000 USD

Benefits

• Comprehensive medical, dental, vision, and life insurance coverage
• 401(k) retirement plan with employer match
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
• Paid time off (PTO) and disability leave
• Employee Assistance Program (EAP)

Equal Employment Opportunity

At Point C Health, we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.