Employee Benefits Customer Service Representative

Role overview This customer service role supports employee benefits clients of a US insurance brokerage, handling claims resolution, benefits inquiries, coverage eligibility, and related issues. Representatives work closely with clients, plan administrators, and carriers by phone and email, aiming to close cases within a 24-hour service window. The position is part of a benefits consulting team and involves educating employees on plan utilization while maintaining detailed interaction records.

Responsibilities - Respond to employee insurance concerns, benefits questions, claims resolution, patient advocacy, and pre-certification support - Educate client employees on optimal benefit utilization and cost-effective plan options - Document interactions in Salesforce, generate client analysis reports, and use the platform to enhance service quality - Monitor resolution timelines to confirm claims and benefits issues are closed within the designated timeframe - Review Summary Plan Descriptions and benefit summaries for accuracy - Act as a primary resource on insurance billing, coding, group benefits, and plan descriptions - Handle member eligibility inquiries, enrollment entry, and confirmation of coverage

Requirements - Three or more years of customer service or call center experience - Background with an insurance carrier, broker, or related vendor - Working knowledge of eligibility, claims, medical coding, and billing - Familiarity with benefit summaries and Summary Plan Descriptions - Strong verbal and written communication, organization, and multitasking skills - Proficiency with Microsoft Office Suite

Nice to have - Spanish language proficiency (written and spoken)

Benefits and work setup - Hourly pay range of $22 to $25 USD - Medical, vision, and dental coverage - 401(k) with company match - Company-paid life insurance plus short- and long-term disability - Generous PTO starting at 18 days per year, plus 10 paid holidays and 2 floating holidays