Benefits & Claims Customer Advocate

zenithamerican; Alameda (CA); On-site; USD 44,000 - 48,000; Full time

Job summary

Zenith American Solutions seeks a Customer Care Advocate to provide customer service to participants, beneficiaries, union locals, and providers regarding eligibility, benefits, and claims status.

The role involves handling PHI/PII with appropriate access and duties include maintaining plan knowledge, documenting inquiries, processing enrollments, and communicating regulatory materials. This position is 40 hours per week and non-exempt, with salary disclosed.

Qualifications

• High school diploma or GED.
• Six months of experience working in customer service, third-party administrator processing, or benefits administration.
• Strong work ethic and team player mentality.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Ability to communicate clearly and professionally, both verbally and in writing.
• Solid organization skills with strong detail orientation and listening skills.
• Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.
• Proficient computer skills including MS Office tools and applications.

Responsibilities

• Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions.
• Provides written, verbal, or face-to-face customer service by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.
• Updates files, including documenting system notes of conversations or action taken.
• Performs tasks associated with the administration of retirement and health and welfare benefits such as; Processing and/or sending mailers or required forms as requested by members.
• Processing and/or sending correspondence related to member or claims status.
• Processing enrollments and updating member information in applicable system(s).
• Distributing communications related to regulatory requirements.
• Initiates Action Requests to appropriate departments requesting adjustments to claims, retirement, and/or eligibility as necessary. Follows up to ensure successful completion of Action Request.
• Researches and resolves complex and technical issues and irregularities.
• Performs other duties as assigned.

Education

High school diploma or GED

Job description

Zenith American Solutions seeks a Customer Care Advocate to provide customer service to participants, beneficiaries, union locals, and providers regarding eligibility, benefits, and claims status.

The role involves handling PHI/PII with appropriate access and duties include maintaining plan knowledge, documenting inquiries, processing enrollments, and communicating regulatory materials. This position is 40 hours per week and non-exempt, with salary disclosed.