Health & Welfare Service Representative (Troy, MI)

BeneSys, Inc.; Troy (MI); On-site; USD 26,000 - 37,000; Full time

Benefits offered by this job

12 paid holidays

PTO

Up to 20 days paid jury leave

Medical, dental, and vision insurance

401k with employer match

Referral bonus

Annual opportunities for raises

Job summary

BeneSys, Inc. in Troy, Michigan is seeking a Health & Welfare Service Representative to handle participant calls regarding eligibility and enrollment. You will determine, maintain and terminate member eligibility for health care and benefits in a fast-paced call center.

The role requires knowledge of SPD plan rules, strong customer service, and ability to manage multiple tasks in a busy environment. In-office schedule with potential for after six months of at-home flexibility.

Qualifications

• Excellent customer service skills required.
• Proficient in Word, Outlook and Excel.
• Spanish speaking preferred.
• Post-High School education or related work experience preferred.

Responsibilities

• Answer participant calls and resolve participant issues.
• Know plan rules for eligibility per SPD for each fund.
• Assist members with all eligibility issues for benefits.
• Explain eligibility rules to members and dependents.
• Send enrollment documents for adding dependents or spouses.
• Enrollment verifications and death notifications.

Skills

Customer service

Spanish language

Education

Post-High School education or related work experience

Tools

Word

Outlook

Excel

Job description

Please see below for a current listing of available positions at BeneSys.

Position:Health & Welfare Service Representative (Troy, MI)

Location: Troy, MI

Job Id:2667

# of Openings:1

Health & Welfare Service Representative(Troy, MI)

Summary

–This is a fast paced, call center environment.The primary responsibilities in this position are to answer participant and dependent phone calls regarding eligibility and enrollment as well as determine, maintain and terminate member and/or dependent eligibility for health care and benefits.

Essential Duties and 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.

Qualifications –

Excellent customer service skills are a must. Proficient in the use of Word, Outlook and Excel.

Preferred Qualification

- Spanish speaking.

Education and/or Experience –

Post-High School education or prior related work experience preferred.

Language Skills –

Good oral and written communication skills. Ability to read and interpret eligibility rules as outlined in the SPD, user manuals for on-line services, department rules and procedures manual, COBRA Compliance manual. Ability to speak clearly and effectively explain to members, dependents, providers and union officials the month-to-month eligibility rules and requirements for coverage.

Mathematical Skills –

General math skills with the ability to calculate hours and rates to determine self-payments and hour banks.

Reasoning Ability –

Must be capable of thoroughly analyzing vendor invoices and all month-end reports, find discrepancies in member’s eligibility, make necessary corrections based on department procedures, understand Plan rules and analysis of member’s eligibility.

Physical Demands –

Must be able to sit for up to eight hours each day answering incoming calls and preparing various correspondence using a variety of office equipment. Must be able to stand for one-to-three-hour intervals while completing filing tasks, organizing department fulfillment center, standing at copy machines to make packages.Occasional lifting of paperwork, eligibility packages, Summary Plan Description boxes.Must be able to move to different workstations as position needs warrant.

Work Environment –

Fast-paced department. Phone calls are continuous and occasionally unpleasant. Must be able to maintain composure with difficult callers. Most work is done independently. Must be able to multi-task. Must be detail oriented. May have to manage several projects at one time and may be interrupted frequently to meet the needs and requests of multiple clients. The environment is busy, noisy and requires excellent organizational, time, and stress-management skills to complete the required tasks.

Work Schedule

Full time. Monday – Friday, 7:30am - 4:30pm. Requires in-office days but also offers at-home flexibility after six months.

Competitive Benefits and Compensation Package

• 12 paid holidays
• Paid Time Off (PTO)
  • Pro-rated during first year of employment
  • 15 days of PTO provided in the next calendar year!
• Up to 20 days paid jury leave
• Medical, dental, and vision insurance, with option for dependent coverage
• Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
• 401k with employer match
• Referral bonus for all successful full-time referrals
• Annual opportunities for increases

Pay

The hourly rate is $23.00. Actual rate dependent on location, skills, education, experience and other business factors.

Our Culture

BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.

Our culture focuses on three core values:

• Collaboration: working together across 31 locations to achieve the best for the company and our clients
• Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
• Integrity: doing what we say we will do. Upholding strong ethical and moral principles

ADA & EEO

Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.