Job Description
Job Description
The Health Benefits Insurance Customer Representative is responsible for delivering exceptional customer service to individuals and employers regarding health insurance benefits and coverage. This role involves educating members about their health insurance options, assisting with claim inquiries, resolving issues, and supporting the administration of health benefits programs.
Key Resposibilities:
Customer Service & Support:
Serve as the primary point of contact for members, employers, and brokers regarding health insurance benefits, policies, claims, and coverage options. Address inquiries related to plan benefits, coverage changes, claim status, and enrollment procedures.
Benefit Explanation & Enrollment Support:
Provide clear explanations of health insurance coverage, benefits, premiums, copays, deductibles, and out-of-pocket costs. Assist members with enrollment, renewals, and updates to their health benefit plans, ensuring all changes are accurately processed.
Problem Resolution:
Investigate and resolve issues related to billing, claim denials, and eligibility discrepancies, ensuring that member concerns are addressed efficiently. Work with departments, such as underwriting or claims to expedite solutions.
Documentation & Compliance
Maintain accurate records or member interactions, inquiries, and actions taken using internal systems. Ensure compliance with all relevant regulations, such as HIPAA, and company policies related to privacy and member data protection.
Qualifications:
Knowledge of health insurance products, claims processes, and industry regulations ( e.g. HIPAA).
Excellent communication skills (both verbal and written) and the ability to explain complex information clearly.
Strong problem-solving skills and ability to handle difficult situations with professionalism and empathy.
Proficiency in MS Office Suite (Word, Excel, Outlook) and experience with health insurance software.
Ability to work in fast-paced environment while managing multiple tasks and priorities.
*
Company DescriptionFamily owned family oriented business
Company Description
Family owned family oriented business