Job Description

A. POSITION PURPOSE:

The purpose of the Customer Service Representative is to respond to questions from participants, vendors and clients regarding plan requirements, compliance issues, including without limitation, to advise clients and its participants of appropriate benefits and to resolve any issues they may be experiencing in a quick, friendly and efficient manner.

B.POSITION ACCOUNTABILITIES (In order of importance):

1. Answer incoming calls on 800 lines
2. Resolve benefit and/or claim issues within 24 hours
3. Provide explanation of benefits and plan documents
4. Assist and advise client HR personnel regarding benefit issues or questions
5. Assist and advise Client Service Representative(s) and Administration Department of ongoing status of claims and other benefit issues via weekly updates and reports
6. Prepare and deliver new hire packets
7. Timely advise and educate Client(s) of administrative in procedures and any changes thereto
8. Communicate with vendors all benefit issues or client problems and work with the vendors to resolve same
9. Create and furnish monthly reports to Clients:
10. Help-line reports
11. Claim forms/reports
12. Other reports from time to time
13. Assist Client Relations Representatives
14. Assist with implementation of plan benefits with providers, vendors and client
15. Review of Plan Document(s)
16. Order and creation of benefit cards and forms
17. Assist with Re-enrollment and Open Enrollment processes
18. Client/Employee orientation and benefit meetings
19. Audits
20. Coverage Cards to Plan Document(s)
21. Enrollments and eligibility
22. CBR System with various providers
23. Other tasks and duties as may be assigned from time to time.

C.POSITION QUALIFICATIONS:

Education: Four-year degree or equivalent work experience

Experience: 1-3 years of handling medical and dental claim issues. Six months of medical eligibility experience. One year of customer service experience.

Knowledge and Skills :Knowledge of self-funding for medical, dental, life, flex, and other benefits. Also, knowledge of ERISA including COBRA and HIPAA helpful. Ability to prioritize and resourcefulness necessary. Also, Computer skills on Windows 95 (necessary), paradox, excel, and Word (helpful).

Other Requirements: Strong interpersonal and communications skills. Ability to cope with a variety of situations and manage several accounts without difficulty.