Description We are looking for a dedicated Participant Services Representative to join our team in Los Angeles, California. In this long-term contract role, you will serve as a vital point of contact for participants, providers, and business managers, offering assistance with benefit inquiries and claims resolution. This position requires exceptional communication skills and a thorough understanding of health plan coverage and processes. Responsibilities: • Provide comprehensive benefits information for medical, dental, and vision claims to participants, providers, and their business managers. • Address inquiries related to prescription vendor coverage, including authorization processes and benefit verification. • Resolve questions surrounding dental and vision benefits, ensuring participants receive accurate and timely assistance. • Investigate and resolve claims payment issues by accessing system records, reissuing documentation, and collaborating with claims examiners. • Follow up with callers to provide detailed explanations of claim resolutions and address any lingering concerns. • Refer to health plan documentation and medical guidelines to determine the eligibility and coverage of various claims. • Maintain consistent and reliable attendance while adhering to departmental policies and procedures. • Accept supervisory direction and implement developmental feedback to improve performance and service delivery. • Establish effective working relationships with colleagues and individuals across all organizational levels. • Perform additional tasks as assigned to support departmental objectives. Requirements • High school diploma required; some college coursework preferred. • Minimum of two years of experience in claims processing or customer service within the group health insurance industry. • Proficient in health insurance systems and tools such as Allscripts, Cerner Technologies, CRM platforms, and Dentrix Dental Software. • Strong analytical abilities with excellent math skills to assess claims and resolve issues effectively. • Outstanding communication and interpersonal skills to interact professionally with diverse stakeholders. • Exceptional organizational skills and attention to detail to manage multiple tasks efficiently. • Self-motivated and capable of working independently with minimal supervision. • Ability to adapt to direction and feedback from supervisors while maintaining a high level of professionalism. TalentMatch® ­Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. Robert Half will consider for employment qualified applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .