Principal Duties and Responsibilities
Obtain, accurately interpret, and maintain a thorough working knowledge of all Summary Plan Description provisions, including multiple benefit schedules, as well as a clear understanding of the eligibility system, claim payment system, and the reciprocity system.
Support, promote, and consistently deliver a premier participant experience.
Respond timely and accurately to phone calls, emails, walk-in participants, and written correspondence by:
Answering questions
Explaining claim payments and reasons for any claim denials
Quoting self-payment amounts
Verifying eligibility and/or benefits
Researching eligibility or claim issues
Updating eligibility with external vendors
Demonstrate honesty, integrity, compassion, and empathy in all interactions.
Escalate participant-related concerns to the appropriate individual(s) for timely and accurate resolution.
Document all phone calls accurately and promptly in the customer service system.
Perform various clerical duties (e.g., entering enrollment forms, processing working-spouse forms).
Navigate and provide accurate information regarding the organization’s benefits website.
Monitor incoming calls and calls waiting through the call management system.
Pick up and handle messages from the nightline/after-hours system.
Work on special projects as assigned by management.
Perform other duties as assigned.
Required and Preferred Knowledge, Skills, and Abilities
Minimum 1 year of customer service experience.
Ability to type at least 40 wpm.
High school diploma required.
Demonstrated initiative and drive to serve others, learn, and succeed.
Excellent written and verbal communication skills.
Proficiency with Microsoft Office applications.
Dependability — ensures timely arrival and consistent attendance to support participants and meet team goals.
Ability to manage issues while maintaining a flexible, positive, caring, and cooperative demeanor.
Responds promptly to operations leaders and stakeholders to facilitate informed decision-making.
Troubleshoots assigned issues by gathering evidence and investigating relevant information with participants, vendors, and internal departments to resolve problems collaboratively.