TPA Service Representative
2 weeks ago
Serve as group contact and customer service representative for GroupCare clients.
RESPONSIBILITIES AND DUTIES
- Serve as contact person (either primary or backup) for employer group representatives.
- Assist with training new employer group representatives on Everence processes, etc.
- Notify the group of plan changes or updates.
- Process enrollments, cancellations, and employee changes.
- Process billing, enrollments, cancelations, and employee changes for the NABCO program for GroupCare and CEP.
- Process Surplus Distributions for employer organizations according to guidelines set forth by each Everence-administered medical plan pool.
- Process wellness claims according to guidelines set forth by each Everence-administered medical plan pool.
- Process COBRA/Continuation including offering COBRA/Continuation for employees who qualify; enroll and cancel employees in COBRA/Continuation; and collect premium.
- Provide reporting as needed using various software packages.
- Introduce EasyApps (a system for enrollment and coverage maintenance) to employer group representatives.
- 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.
- Maintain a working knowledge of MyEverence for Organizations.
- Develop and maintain uniform procedures.
- Cross-train and back-up other GroupCare representatives.
- Complete projects or assignments as directed by the manager.
QUALIFICATIONS
Experience:
- Prior experience in insurance or Human Resources processes/benefits preferred
Skills and Abilities:
- A high sense of urgency, initiative, organizational skills, good judgment, problem-solving abilities, and ability to keep information confidential
- Excellent attention to detail
- Ability to handle multiple tasks and interruptions with efficiency, calmness, and courtesy; ability to self-direct
- Strong relational and communication skills
- Ability to handle difficult situations with tact and diplomacy
- Ability to work well in a team atmosphere and with other team members
- Vision-oriented to continually look for improvements in work processes and opportunities for growth
- Excellent written and verbal communication skills
- Advanced working knowledge of PC-based software, including Microsoft Suite
SUPERVISORY RESPONSIBILITIES: None
SCHEDULE: Full-time
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