Customer Service Representative

3 days ago


El Paso, Texas, United States First Insurance Group Full time
Job Summary

We are seeking a highly skilled and customer-focused Customer Service Representative to join our team at First Insurance Group. As a key member of our team, you will be responsible for providing exceptional customer service support to our clients, working closely with our Benefits Consultants, Benefits Account Executives, and Benefit Account Managers to retain and expand customer relationships.

Key Responsibilities
  • Answer and direct incoming agency calls as needed.
  • Maintain knowledge of client-specific plans to field employee and client benefit-related questions.
  • Investigate client claims issues, including diagnosis, procedures, proper coding, and proper billing.
  • Communicate resolution procedures and timelines to clients.
  • Contact healthcare providers as needed to obtain medical records for claim resolution.
  • Assist clients with provider searches, appeals of denied services, explanation of benefits, and EOBs.
  • Assist clients with prescription benefit issues, overrides, prior authorizations, and alternative medications.
  • Communicate with carriers regarding claim issues, prior authorization reviews, and plan benefits inquiries.
  • Log claim issues, service issues, notes, and phone calls in Epic.
  • Process online and paper eligibility for all applicable clients in a prompt and accurate manner.
  • Provide onsite and phone FormFire assistance.
  • Communicate eligibility to carriers via online enrollment systems, via fax, email, or phone.
  • Participate in client employee meetings, answer questions, and assist as needed.
  • Assist in the preparation of presentations, reports, and special projects as needed.
  • Maintain current client and carrier contacts listings in conjunction with the Benefits Account Executives and Benefits Account Managers.
  • Assist Benefits Account Executives and Benefits Account Managers with renewal and mid-year timelines, reporting, and presentations.
  • Maintain client data storage and record keeping in Epic.
  • Complete continuing education requirements to renew health and life insurance licenses.
  • Participate in various community events and activities.
  • Complete special projects and other duties as assigned.
Requirements
  • Associates degree in a related business field, or equivalent experience.
  • Health and life insurance license required or willingness to obtain.
  • Three years of insurance experience preferred.
Skills and Knowledge
  • Strong knowledge of computer software applications, including Excel and PowerPoint.
  • Strong interpersonal, verbal, and written communication skills.
  • Goal-oriented personality, with a high degree of professionalism.
  • Excellent organizational and customer service skills.
  • Analytical, problem-solving, and critical thinking skills.
  • Ability to be proactive and forward-thinking, with flexibility and time management skills.
  • Confidentiality and adherence to HIPAA security guidelines.
  • Knowledge and understanding of the agency's products, services, policies, and procedures.
  • Overall knowledge of the insurance industry, including a good understanding of insurance industry regulations, knowledge of carriers' products, and available coverage.
Work Environment

This job operates in a professional office environment. Work is normally performed in a typical interior work environment that does not subject the employee to any hazardous or unpleasant elements.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to speak or hear, stand or sit for long periods of time, open filing cabinets, walk, stoop or bend, use hands to handle or feel, and reach with hands and arms. The employee must frequently lift and/or move up to 10 pounds, occasionally lift and/or move up to 25 pounds, and complete tasks requiring manual dexterity. Ability to drive a vehicle for travel is required for the position.



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