Benefit Services Representative

This position reports to the Benefit Services Supervisor and is responsible for providing service to the members of the PEBTF by determining requirements; answering inquiries; resolving problems; fulfilling requests; and maintaining the Fund’s database. The Benefit Services Representative, courteously and professionally, handles inquiries including, but not limited to, verifying eligibility and information about the health plan programs administered/supported by the PEBTF.

The successful candidate will possess the ability to:

• Project a professional image of the PEBTF through various telephone interactions.
• Consistently provide, over the telephone and through email, superior levels of customer service by verifying eligibility, explaining benefits and wellness programs with accuracy and interacting with customers in a high quality manner.
• Effectively interact with other PEBTF departments/employees by accurately, and in a timely manner, reporting issues that warrant further clarification, and/or further investigation into member issues.
• Accurately complete inquiry forms, screen prints and/or other worksheets.
• Maintain accurate and correct information regarding all incoming and outgoing calls in the Customer Tracking System (CUT) system or Service Request at the time of call.
• Open and close all issues in HealthRules in a timely manner.
• Strictly adhere to all HIPAA and Fund Privacy and Security policies and procedures and perform member verifications in accordance with them.
• Assess and research member complaints and offer proper solutions.
• Obtain and evaluate all relevant data to handle complaints and inquiries.
• Handle inbound and outbound calls, and faxes from the PEBTF’s members and business partners.
• Transfer member or business partner calls with complex inquiries to the Benefit Services Team Leader or Supervisor.
• Recommend process improvements.
• Ensure and maintain confidentiality of personal health information.
• Provide thorough benefit, eligibility and statistical information on a timely basis
• Able to handle multiple projects simultaneously.
• Perform other duties as assigned by PEBTF management.

These skills, knowledge and experience are required:

• High school diploma or equivalent.
• One to three years of experience in telephone customer service, in a health insurance setting.

Knowledge requirements:

• Knowledge of eligibility (enrollment), claims, dental, and prescription systems.
• Knowledge of health insurance programs such as Indemnity, HMO, POS, PPO, Medicare and Medicare Supplemental, Vision, Prescription, Dental, Hearing Aid, and MRP plans.
• Excellent listening skills.
• Excellent verbal and written communication skills.
• Strong interpersonal skills
• Excellent organizational and reference skills.
• Excellent analytical skills.
• Excellent PC skills including Microsoft Office tools (Outlook, Word, Excel and Powerpoint),
• Good keyboarding skills.

Strong ability to prioritize work.

Ability to work independently and as a team member.

Ability to speak frequently, listen using a headset, sit, use his/her hands/fingers across keyboard or mouse, handle other objects, and work at a computer for long periods.

Ability to work within a service center environment with moderate noise level due to other Representatives speaking, noise from computers, printers, and other floor activity.

This position requires the candidate to spend the majority of the work day sitting at a workstation and affords little movement about the office.

Travel is negligible.

These are the physical requirements for this position:

• Sitting at a desk for extended periods of time working with a computer and monitor.
• Occasional walking for short distances within the facility.
• Adequate vision in order to read the computer screen and paper documentation.
• Adequate hearing in order to perform customer service activities via the telephone.
• Ability to lift up to 10 lbs.

These skills, knowledge and experience are preferred:

• Associate’s degree in healthcare or a related field.

Job Type: Full-time

Pay: From $20.34 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

People with a criminal record are encouraged to apply

Work Location: In person

Salary : $20