Health Benefits Support Specialist

your Jared; Northern (KY); Hybrid; USD 40,000 - 56,000; Full time

Job summary

PEHP Health & Benefits, a division of the Utah Retirement Systems, seeks a customer-focused benefits advocate to assist members and providers with claims, eligibility, and billing questions. You'll explain coverage, navigate websites, and resolve issues with care.

This role emphasizes accuracy, confidentiality, and excellent communication in a collaborative environment. Remote work is available most days, with a balanced schedule and strong benefits.

Qualifications

• High School Diploma and one year of progressively responsible experience performing a variety of duties relating to customer service; OR an equivalent combination of education and experience.
• Specific experience in health insurance call centers, customer service, or claims adjudication, preferred.
• Strong communication and computer skills are essential.

Responsibilities

• Receives and responds to incoming phone calls from policy holders, claimants, providers, and other insurers; quotes benefits and provides claim status.
• Greets the public and meets with policyholders about medical and dental issues related to benefits, claims, and payment status.
• Educates members and providers on website tools and assists with online changes and updates; troubleshoots account issues including setup and password resets.
• Identifies erroneous claims adjudication, member enrollment, provider setup, prior authorization, and coordination of benefits in a timely manner.
• Makes outgoing calls to assist members and providers in submitting information for benefits, claims processing, preauthorization, and appeals.
• Provides walk-in clients with forms and information; directs visitors and maintains confidentiality.
• Interprets policies for walk-in clients to determine coverage; coordinates with Pharmacy dept for related issues.
• Advises callers in claims processing, corrections, and appeals; handles faxes and emails with various computer resources.
• Documents benefit quotes and ensures accurate records of communications.
• Maintains regular attendance and confidentiality.
• Performs other related duties as required.

Skills

Customer service

Phone etiquette

Communication skills

Microsoft Office

Education

High School Diploma

Tools

Healthcare information systems

CRM systems

Job description

PEHP Health & Benefits, a division of the Utah Retirement Systems, seeks a customer-focused benefits advocate to assist members and providers with claims, eligibility, and billing questions. You'll explain coverage, navigate websites, and resolve issues with care.

This role emphasizes accuracy, confidentiality, and excellent communication in a collaborative environment. Remote work is available most days, with a balanced schedule and strong benefits.