Employee Benefits Customer Service Representative

Foundation Risk Partners, Corp.; Philadelphia (Philadelphia County); On-site; USD 30,000 - 34,000; Full time

Benefits offered by this job

Health benefits

401(k) with company match

Life insurance

STD/LTD

PTO 18 days + holidays

Job summary

Foundation Risk Partners, Corp. is seeking an Employee Benefits Customer Service Representative to handle benefits inquiries, claims resolution, and eligibility questions for clients and employees.

You will work closely with clients and carriers via phone and email to resolve matters within a 24-hour timeframe. The role requires strong communication, organization, and problem-solving skills, with experience in a call center or insurance environment.

Qualifications

• 3+ years in customer service/call center environment
• Experience with an insurance industry carrier, broker, or insurance related vendor
• Knowledge of eligibility claims, medical coding and billing
• Knowledge of benefit summaries and Benefit Plan Descriptions
• Proficiency in Spanish is a plus
• Strong communication and service orientation

Responsibilities

• Address client employee insurance concerns and assist with claims resolution and enrollment.
• Educate client employees on benefit utilization and plan options.
• Maintain records and enter data into Salesforce; generate client analysis reports.
• Use Salesforce to gather client information and improve service quality.
• Monitor resolution timelines to ensure timely closure of issues.
• Review SPDs and benefit summaries for accuracy.
• Provide expertise on insurance billing, coding, and plan descriptions to clients.
• Serve as a primary resource within the team for issue resolution and customer support.

Skills

Verbal & written comms

Organization & multitasking

Problem solving

Initiative & prioritization

Team collaboration

Detail-oriented

Microsoft Office

Spanish (nice to have)

Tools

Salesforce

CRM software

Job description

Employee Benefits Customer Service Representative

Job Summary:

The Employee Benefits Customer Service Representative handles claims resolution, benefits inquiries, coverage eligibility concerns, and other related issues for our clients' administrators and employees. They work closely with clients and carriers via phone and email to resolve matters within a 24-hour timeframe.

Essential Functions

• Address client employee insurance concerns, answer benefit-related questions, and assist with claims resolution, patient advocacy, and pre-certifications.
• Educate client employees on optimal benefit utilization and provide guidance on cost-effective plan options.
• Maintain detailed records of client interactions, entering data into Salesforce and generating client analysis reports as necessary.
• Use Salesforce to gather client information and enhance service quality.
• Monitor resolution timelines to ensure benefit issues and claims are closed within the designated timeframe.
• Review Summary Plan Descriptions (SPDs) and benefit summaries for accuracy.
• Offer expertise on insurance billing, coding, employee group benefits, insurance processes, and plan descriptions to clients.
• Act as a primary resource within the team, delivering exceptional customer service and support in resolving insurance and benefit-related issues.
• Address member eligibility inquiries, enrollment entry and confirmation of coverage.

Competencies & Qualifications

• Exceptional verbal and written communication abilities.
• Outstanding organizational and multi-tasking capabilities.
• Strong problem-solving skills.
• Skilled at taking initiative, prioritizing tasks, and meeting tight deadlines.
• Proficiency in Spanish (both written and spoken) is a plus.
• Collaborative team member.
• Adaptable and detail-oriented.
• Proficient in Microsoft Office Suite.

Education & Experience

• Three plus years’ experience working in customer service/call center environment.
• Experience with an insurance industry carrier, broker, or insurance related vendor.
• Knowledge of eligibility claims, medical coding and billing, etc.
• Knowledge of benefit summaries and Benefit Plan Descriptions.

This range represents the estimated low and high end of the salary range for this position. Actual salaries will vary and may be above or below the range based on factors including but not limited to performance, location, and experience. The range listed is just one component of FRP's total compensation package for employees.

Pay Transparency Range

$22 - $25 USD

Disclaimer:

While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add, or remove duties from particular jobs and to assign other duties as necessary.

Equal Employment Opportunity (EEO):

FRP provides equal employment opportunity to qualified persons regardless of race, color, sex, religion, national origin, age, sexual orientation, gender identity, disability, veteran status, or any other classifications protected by law.

FRP offers a comprehensive range of health-related benefit options including medical, vision, and dental. We offer a 401(k) with company match, company paid life insurance, STD, LTD and a generous PTO policy starting at 18 days per year plus 10 paid holidays & 2 floating holidays!