What are the responsibilities and job description for the Employee Benefits Claims/Coverage Advocate position at Corporate Synergies?
Foundation Risk Partners, one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Customer Service Advocate to their Corporate Synergies team in Philly Metro Region.
Job Summary:
The Benefits VIP 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.
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.
Benefits:
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!
