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TPA Service Representative

4 months ago

Goshen, United States Everence Full time

POSITION SUMMARY

Serve as group contact and customer service representative for GroupCare clients.

RESPONSIBILITIES AND DUTIES

  1. Serve as contact person (either primary or backup) for employer group representatives.
  2. Assist with training new employer group representatives on Everence processes, etc.
  3. Notify the group of plan changes or updates.
  4. Process enrollments, cancellations, and employee changes.
  5. Process billing, enrollments, cancelations, and employee changes for the NABCO program for GroupCare and CEP.
  6. Process Surplus Distributions for employer organizations according to guidelines set forth by each Everence-administered medical plan pool.
  7. Process wellness claims according to guidelines set forth by each Everence-administered medical plan pool.
  8. Process COBRA/Continuation including offering COBRA/Continuation for employees who qualify; enroll and cancel employees in COBRA/Continuation; and collect premium.
  9. Provide reporting as needed using various software packages.
  10. Introduce EasyApps (a system for enrollment and coverage maintenance) to employer group representatives.
  11. Stay abreast with the regulatory environment, such as Affordable Care Act and Health and health insurance regulatory rulings, pertaining to self-funded groups, and distribute information as needed.
  12. Maintain a working knowledge of MyEverence for Organizations. 
  13. Develop and maintain uniform procedures.
  14. Cross-train and back-up other GroupCare representatives.
  15. Complete projects or assignments as directed by the manager.

QUALIFICATIONS

Experience: 

  1. Prior experience in insurance or Human Resources processes/benefits preferred

Skills and Abilities:

  1. A high sense of urgency, initiative, organizational skills, good judgment, problem-solving abilities, and ability to keep information confidential
  2. Excellent attention to detail
  3. Ability to handle multiple tasks and interruptions with efficiency, calmness, and courtesy; ability to self-direct
  4. Strong relational and communication skills
  5. Ability to handle difficult situations with tact and diplomacy
  6. Ability to work well in a team atmosphere and with other team members
  7. Vision-oriented to continually look for improvements in work processes and opportunities for growth
  8. Excellent written and verbal communication skills
  9. Advanced working knowledge of PC-based software, including Microsoft Suite

SUPERVISORY RESPONSIBILITIES:  None

SCHEDULE:   Full-time