Client Services Representative I

Western Growers Health; Irvine (CA); On-site; USD 55,000 - 70,000; Full time

Job summary

Western Growers Health is seeking a Client Service Representative I (CTSR) to educate participants, enroll them, and support benefits administration for WGAT/PCMI plans. The role emphasizes bilingual Spanish proficiency and collaboration with vendors, with remote work available for residents of Southern or Central California.

Responsibilities include educating participants, handling enrollment, answering inquiries, generating reports, and supporting meetings and events while traveling up to 40%

Responsibilities

• Educate newly enrolled and existing plan participants on health plan and ancillary benefits at group’s work site locations, via phone or virtual platforms.
• Conduct group benefits presentations in both English and Spanish for WGAT and PCMI plan participants.
• Interface with third party vendors/providers to communicate and educate them on benefits and programs specific to WGAT plan participants.
• Provide one-on-one support to address applicant concerns or questions.
• Serve as the primary contact for questions regarding benefits utilization.
• Assist with enrollment of participants, screen all enrollment paperwork for accuracy and completion.
• Work with Client Service Supervisor to organize assigned group service meetings and open enrollment for the most economical and effective use of time.
• Research and respond to WGAT and PCMI participant claim and administration questions utilizing the Health Care Processing system and the CTSR web-based tool(s).
• Determine necessary corrective action for problem/issue resolution using established documentation procedures and protocol.
• Request Benefits Information Booklet and Benefit Summaries/SBCs for health benefit information specific to each account.
• Support Regional Sales Manager/Account Manager/Broker/Client with plan comparisons, pre-filled enrollment/waiver forms, and any other materials or requests as needed.
• Attend employee client events to assist with benefits inquiries, provide materials to plan participants, and promote and enroll plan participants in value-added programs.
• Compile and track data pertaining to problems/issues, action taken and resolutions using the CTSR web-based tool.
• Document all services to include; enrollments, service meetings, employee client events, wellness events, courtesy calls and visits utilizing the CTSR web-based tool.
• Generate reports on metrics and suggest improvements to processes.
• Utilize all capabilities to satisfy one mission: To enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a Helpful and collaborative manner.
• Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 40% of the time.
• Other duties as assigned.

Job description

The Client Service Representative I (CTSR) reports directly to the Supervisor of Client Services and is responsible for the enrollment, implementation, and education of Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management. Inc. (PCMI) health benefit plan participants. This position also involves collaborating with third-party vendors related to employee health benefits. This includes the investigation of problems/issues to determine the source of the problem, evaluation of investigation results, and determination of necessary corrective action for problem/issue resolution using established procedures and protocol.

BILINGUAL IN SPANISH IS REQUIRED.

This position is fully remote, but applicants must reside in Southern or Central California to be considered.

Duties And Responsibilities

Education Services

• Educate newly enrolled and existing plan participants on health plan and ancillary benefits at group’s work site locations, via phone or virtual platforms.
• Conduct group benefits presentations in both English and Spanish for WGAT and PCMI plan participants.
• Interface with third party vendors/providers to communicate and educate them on benefits and programs specific to WGAT plan participants.
• Provide one-on-one support to address applicant concerns or questions.
• Serve as the primary contact for questions regarding benefits utilization.

Member Services

• Assist with enrollment of participants, screen all enrollment paperwork for accuracy and completion.
• Work with Client Service Supervisor to organize assigned group service meetings and open enrollment for the most economical and effective use of time.
• Research and respond to WGAT and PCMI participant claim and administration questions utilizing the Health Care Processing system and the CTSR web-based tool(s).
• Determine necessary corrective action for problem/issue resolution using established documentation procedures and protocol.
• Request Benefits Information Booklet and Benefit Summaries/SBCs for health benefit information specific to each account.
• Support Regional Sales Manager/Account Manager/Broker/Client with plan comparisons, pre-filled enrollment/waiver forms, and any other materials or requests as needed.
• Attend employee client events to assist with benefits inquiries, provide materials to plan participants, and promote and enroll plan participants in value-added programs.

Data Collection

• Compile and track data pertaining to problems/issues, action taken and resolutions using the CTSR web-based tool.
• Document all services to include; enrollments, service meetings, employee client events, wellness events, courtesy calls and visits utilizing the CTSR web-based tool.
• Generate reports on metrics and suggest improvements to processes.

Other

• Utilize all capabilities to satisfy one mission: To enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
• Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 40% of the time.
• Other duties as assigned.

PHYSICAL DEMANDS/WORKENVIRONMENT

The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to travel to both indoor and outdoor areas that can vary in exposure and temperature. The employee is frequently required to operate a motor vehicle, use objects, tools, or controls, and/or required to lift up to 50lbs. The noise level in the work environment is usually moderate.