ERC Benefit Specialist

Position Summary

The Employee Response Center (ERC) Benefits and Claims Specialist is a key role in the Financial Services Day 2-ERC Department at Higginbotham. The role is responsible for ensuring a thorough knowledge of claims, research tools, and resources to serve employees and employers effectively. This role is centered around evaluating and reviewing claims with precision and accuracy.

Essential Tasks

• Maintaining documentation, spreadsheets, products, and services as requirements change
• Serving as a subject matter expert on reviewing and assessing insurance claims, analyzing documentation, calculating benefit payments, liaising with claimants and insurance agents, utilizing specialized software, interpreting policy coverage, negotiating settlements, and providing expert testimony
• Driving continuous process improvements and creating the claim/customer service process, training documentation, and manual
• Assisting Account Managers/Producers in the setup and maintenance of required Claim Services
• Aiding in creating/Writing Standard Operating Procedures (SOP)
• Answering and advising clients (employees, retirees, and dependents) regarding their benefit plans as appropriate
• Researching questions and issues as necessary, including discussions with appropriate Carriers and Producer Teams
• Aiding in client (employees, retirees, COBRA participants, dependents) enrollment into the appropriate enrollment tool (paper or electronic)
• Logging all activity into designated software for reporting purposes (documenting all calls and emails and comments in EPIC)
• Ensuring that all client requests (calls, voicemails, emails, etc.) are answered within 3 business hours (i.e., voicemail is left at 5:00pm on Friday, call must be returned by 11:00am on Monday)
• Returning employee, client, and Account Manager phone calls and emails promptly
• Enrolling employees according to their current enrollment systems
• Answering benefits, HR, and claims-related calls as needed by clients
• Aiding with COBRA Administration as needed
• Building and maintaining processes and templates (with Management assistance) to complete tasks more efficiently and effectively
• As time allows, assisting and cross-training on other team functions
• Aiding in marketing Higginbotham’s products and services to clients and prospects as requested

Core Competencies

• Ability to Analyze and Solve Problems
• Attention to Detail
• Communication Skills
• Timely Task Completion
• Team Collaboration
• Client Focus
• Dependability
• Creative Thinking
• Organizational Skills
• Adaptability

Experience and Education

• 5+ years of employee benefits, insurance experience, claims-carrier knowledge, and customer service in business/industry experience required
• Bilingual / Spanish preferred
• Proficient understanding of employee benefit plans and their operations, claims, carriers, and provider relations, including contract interactions
• Knowledge of employee benefits, COBRA administration, and insurance products
• Licensing and Credentials: Active General Lines Insurance License required
• Additional license and certifications for advising employees on insurance products preferred

Systems

• Proficient with Microsoft Excel, Word, PowerPoint, and Outlook
• Applied Epic experience preferred, but knowledge of similar Account Management System (AMS) is acceptable

Physical Requirements

• Ability to lift 25 pounds
• Repeated use of sight to read documents and computer screens
• Repeated use of hearing and speech to communicate on telephone and in person
• Repetitive hand movements, such as keyboarding, writing, 10-key
• Walking, bending, sitting, reaching and stretching in all directions

Benefits & Compensation

• Higginbotham offers medical, dental, vision, prescription drug coverage, 401K, equity incentive plan as well as multiple supplemental benefits for physical, emotional, and financial wellbeing.
• Employee Wellness Program
• Company paid holidays, plus PTO

Notice to Recruiters and Staffing Agencies

To protect the interests of all parties, Higginbotham Insurance Agency, Inc., and our partners, will not accept unsolicited potential placements from any source other than directly from the candidate or a vendor partner under MSA with Higginbotham. Please do not contact or send unsolicited potential placements to our team members. Applications will be accepted until the position is filled.