General Description: Assist clients and their employees with benefit or claim questions. 

Responsibilities: 

Primary resource for clients and their employees with benefit or claim questions.Investigate and work with carrier contacts to solve claim problems.Respond to emails and voicemails within 24 business hours.Track and document all calls and interactions in Call Center database. Assist clients with administrative questions regarding enrollment, eligibility, and special contract provisions.Assist with transition of care concerns due to a change in carrier.Provide help with coordination of benefits.Drafts appeal letters and perform claim audits as needed.Report trends to carrier and/or the account manager.Maintain open call volume in a timely manner.Keep informed about industry information and new product information.

Knowledge, Skills and Abilities:

Prior customer service experience preferred.Must hold or be able to earn a Life and Disability insurance license within 90 days of hire date.Comfortable with internet-based programs and Microsoft Office products.Bilingual preferred, but not required.Strong attention to detail and ability to self-check work.Excellent time management skills, able to set priorities and manage deadlines.Ability to work in a team environment.Resourceful, eager to learn new concepts, and further professional development.Ability to define problems and generate potential solutions. Strong verbal and written communication skills.Ability to remain calm in stressful situations.

Physical Demands:

Work is performed in a climate-controlled office environment with minimal noise and limited to no exposure to chemicals or toxins. Employees operate office equipment including telephone - headset, computer, computer monitors, keyboard, mouse, copier, scanner and mail machine. Physical tasks of job include walking, sitting, standing, bending and typing.

Analysis of Physical Demands:

Constantly (over 66% of time) work performed requires employees to use repetitive hand motions such as typing, using a keyboard, and sitting at a desk.Frequently (34%-66% of time) work performed requires employees to handle and grasp things, walk on normal surfaces, stand and bend.Occasionally (1%-33% of time) work performed requires repetitive foot movements, walk on uneven or slippery surfaces to and from work and occasionally reach outward to grab things and bend.Rarely (< than 1 hour per week) work performed requires lifting/carrying items that range from 10-50lbs, pushing/pulling items that range from 10-50lbs, twisting/ turning including reaching over shoulder or above head, kneeling or squatting.
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