Eligibility & Benefits Specialist - In-Office

BeneSys, Inc.; Canfield (OH); On-site; USD 30,000 - 32,000; Full time

Benefits offered by this job

12 paid holidays

Paid Time Off (PTO)

Medical, dental, and vision insurance

Job summary

BeneSys, Inc. in Canfield, OH is seeking a customer service-focused call center associate to handle participant and dependent calls about eligibility and enrollment.

You will explain plan rules, process enrollment documents, verify eligibility, and coordinate with vendors to resolve issues. The role requires accuracy, communication skills, and the ability to manage multiple tasks in a fast-paced environment.

Qualifications

• Excellent customer service skills are a must.

Responsibilities

• Answer participant calls, mail participant requests and resolve participant issues.
• Know the plan rules for eligibility as outlined in the Summary Plan Description (SPD) for each fund.
• Assist members and their dependents with all issues regarding eligibility for benefits.
• Explain eligibility rules to members.
• Send proper enrollment documents to members adding children or a spouse.
• Enrollment verifications.
• Death Notifications.
• Communicate with various vendors regarding prior authorizations and eligibility issues.
• Comment system when changes are made to Participant record or when Participant calls with request.
• Knowledgeable of policies, procedures and coverage of various funds.
• Assist callers with questions regarding deductibles, out of pocket accumulators, dental, vision and medical benefits, MRA or Bennycard and short-term disability inquiries.
• Status medical, dental and vision claims for members and some providers.
• Maintain records of all interactions with members/providers.
• Make outgoing calls to members, providers, collection agencies and vendors such as BCBSMI, HAP to resolve claim or eligibility issues.
• Follow up with members to ensure any issues are resolved.
• Enter change of address notifications.
• Submit escalations to management for complex calls for assistance.
• Regular and predictable attendance is an essential function of this job.

Skills

Customer service

Word

Outlook

Excel

Education

Post-High School education

Tools

Word

Outlook

Excel

Job description

BeneSys, Inc. in Canfield, OH is seeking a customer service-focused call center associate to handle participant and dependent calls about eligibility and enrollment.

You will explain plan rules, process enrollment documents, verify eligibility, and coordinate with vendors to resolve issues. The role requires accuracy, communication skills, and the ability to manage multiple tasks in a fast-paced environment.