Client Relations Specialist
2 weeks ago
Position Title: Customer Service Representative
Department: First Insurance Group Employee Benefits
Reports to: Vice President, Employee Benefits
Supervises: No Direct Reports
Position Overview:
The Customer Service Representative plays a crucial role in upholding the mission and objectives of First Insurance Group by delivering exceptional support to our clients. This position collaborates closely with Benefits Consultants, Account Executives, and Account Managers to nurture and enhance client relationships. The representative is expected to embody and apply our Trusted Advisor approach to all interactions with both internal and external stakeholders.
Key Responsibilities:
- Manage and direct incoming calls from agencies as necessary.
- Maintain comprehensive knowledge of client-specific plans to effectively address employee and client inquiries regarding benefits.
- Investigate and resolve client claims issues, including diagnosis, procedures, coding, and billing.
- Communicate resolution procedures and timelines to clients.
- Engage with healthcare providers to obtain necessary medical records for claim resolution.
- Assist clients with provider searches, appeals for denied services, and explanations of benefits (EOBs).
- Support clients with prescription benefit inquiries, overrides, prior authorizations, and alternative medication options.
- Coordinate with carriers on claim issues, prior authorization reviews, and inquiries about plan benefits.
- Document claim issues, service interactions, and communications in the Epic system.
- Process eligibility for clients both online and on paper in a timely and accurate manner.
- Provide assistance with FormFire both onsite and via phone.
- Communicate eligibility information to carriers through various enrollment systems.
- Participate in client employee meetings, addressing questions and providing assistance as needed.
- Contribute to the preparation of presentations, reports, and special projects as required.
- Maintain updated client and carrier contact lists in collaboration with Account Executives and Managers.
- Assist with renewal and mid-year timelines, reporting, and presentations.
- Ensure proper storage and record-keeping of client data in Epic.
- Complete continuing education requirements to maintain health and life insurance licenses.
- Engage in community events and activities.
- Undertake special projects and additional duties as assigned.
Qualifications:
Education: Associate's degree in a related business field or equivalent experience. Health and life insurance license required or willingness to obtain.
Experience: A minimum of three years in the insurance sector is preferred.
Skills and Competencies:
- Proficient in computer software applications, particularly Excel and PowerPoint.
- Strong interpersonal, verbal, and written communication abilities.
- Goal-oriented with a high level of professionalism.
- Excellent organizational and customer service skills.
- Analytical, problem-solving, and critical thinking capabilities.
- Proactive, flexible, and effective time management skills.
- Commitment to confidentiality and adherence to HIPAA regulations.
- Comprehensive understanding of the agency's products, services, policies, and procedures.
- Broad knowledge of the insurance industry, including regulations and available coverage options.
Work Environment:
This role is situated in a professional office setting, where work is typically conducted in a standard interior environment free from hazardous conditions.
Physical Requirements:
The physical demands outlined here represent what must be met by an employee to successfully execute the essential functions of this position. While performing the duties of this job, the employee is regularly required to communicate effectively, remain seated or standing for extended periods, open filing cabinets, walk, bend, and use hands for various tasks. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds, requiring manual dexterity. A valid driver's license for travel may be necessary for this position.
Equal Opportunity Statement: First Insurance Group is an Affirmative Action and Equal Opportunity employer. We consider all qualified applicants without regard to race, religion, color, sex, national origin, age, sexual orientation, gender identity, disability, or any other legally protected status.
The above statements are intended to describe the essential functions of the job and the qualifications of the person assigned to it. They are not intended as an exhaustive list of all job duties, responsibilities, and requirements. Duties, responsibilities, and activities may change or new ones may be assigned at any time with or without notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description does not constitute a contract of employment. Employment is at will and may be terminated at any time.
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