Customer Service Representative Insurance Specialist

2 days ago

Frisco, Texas, United States Trinity Captive Group Full time
Job Overview

Trinity Captive Group is revolutionizing the health insurance industry by creating a self-funded captive program that reduces overall plan costs while providing better benefits to employees. As a key member of our team, you will play a critical role in delivering exceptional member care and support.

Key Responsibilities
  • Member Support: Serve as the primary point of contact for plan members, providing prompt and professional responses to inquiries regarding their health benefits, claims, eligibility, and plan details.
  • Benefits Review: Guide members through understanding their self-funded health plan benefits, including covered services, out-of-pocket costs, and how to access care through our network.
  • Eligibility Verification: Review and verify member eligibility for coverage and services, ensuring accurate information is communicated to both members and providers.
  • Claims Assistance: Assist members with claims-related questions, including status updates, benefit determinations, and explaining claim resolutions.
  • Issue Resolution: Address and resolve escalated member concerns, providing accurate and timely solutions to complex issues.
  • Collaboration: Work closely with other partners, such as the claims team and client account managers, to ensure a seamless member experience.
  • Documentation: Accurately document all member interactions and follow up on any pending issues in a timely manner.
  • Compliance: Maintain knowledge of self-funded health plan regulations and ensure all interactions comply with applicable legal standards.
Qualifications
  • Experience: Minimum of 2 years' experience in customer service, within the insurance industry or working with self-funded health plans.
  • Knowledge: Strong understanding of self-funded health insurance concepts, including benefits, eligibility, claims processing, and member services.
  • Skills:
    • Excellent verbal and written communication skills.
    • Strong problem-solving abilities and attention to detail.
    • Ability to navigate multiple systems and databases.
    • Technology Proficiency: Comfortable using CRM systems and other insurance-related software tools.
    • Customer Focus: Ability to empathize with members and provide a high level of support.
    • Team Player: Ability to work collaboratively in a team-oriented environment.
Preferred Qualifications
  • Experience working with third-party administrators (TPA) or in a self-funded insurance setting.
  • Familiarity with claims adjudication systems.
  • Bilingual (Spanish) is a plus.

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