Claims and Service Representative
Department – Operations/Savings and Spending Accounts Customer Service/Administration
Reports to – Customer Service Manager
Classification - Nonexempt
Position Type/Expected Hours of Work - This is a part- or full-time position, and hours of work and days vary and are during Monday through Friday, 8:00am to 9:00 pm ET.
The claims and service representative position is responsible for claims review and processing for account-based employee benefit plans such as health reimbursement arrangements (HRA) and flexible spending accounts (FSA), and for related customer service to participants. The representative provides explanations regarding HRA and FSA benefits and plan provisions to participants, client contacts and internal team members. The representative provides excellent customer service by interacting with internal team members, clients and participants through phone calls and email, and supports efficient administration of plans and department practices.
An individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skills, and/or ability required. Other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Examine, review, process, calculate and pay claims in a timely manner based on claim information, plan design, insurance filings, documentation and reports
- Review and interpret Explanation of Benefits (EOBs) and itemized statements from various insurance carriers and healthcare facilities/providers.
- Comply with plan document provisions, regulations, guidelines and company procedures
- Assist claimants, participants, clients or other designated contacts with trouble-shooting, problems or questions via phone or email
- Enter claims information into system and verify accuracy for processing
- Maintain confidentiality and keep department, client and participant HIPAA compliant
- Acquire and maintain knowledge of employee benefits plans and Chard Snyder service offerings
- Maintain relationships through answering first line of phone calls and emails from participants and clients in a friendly, courteous, professional and timely manner
- Interact with department team members regarding claims
- Scan documents using copy/scan machine
- Provide administrative department support and team assistance as needed
- Organizational Skills
- Technical Capacity
- Problem Solving
- Communication and Interpersonal Skills Proficiency
- Accuracy and Attention to Detail
- Multitasking Proficiency
- Ability to prioritize tasks within specified timelines
This position has no supervisory responsibilities.
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
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. This is largely a sedentary role however some filing may be required. This would require the ability to lift files, open filing cabinets and bending as necessary.
No travel is expected for this position.
Required Education and Experience
- High school diploma or GED, and further applicable education or equivalent experience.
- Ability to add, subtract, multiply and divide all units of measure, using whole numbers, common fraction and decimals, and calculate percentages.
- Ability to read workplace rules and procedures, speak with poise and confidence, using correct English.
- Knowledge of tax-advantaged accounts and benefit plans, insurance, and/or claims.
- Ability and proficiency with Microsoft Office and Excel applications, and claims processing or benefit card systems.
- Ability to handle stressful situations regarding urgent customer needs.
- Six months prior work experience in an office environment.
Preferred Education and Experience
- Two plus years prior work experience in an office environment and with tax-advantaged accounts and benefit plans, insurance, and/or claims preferred.
- Advanced proficiency with Excel and database applications, including formatting and formulas.
- Associate’s degree in related degree program.
If interested, please send a copy of your resume to HumanResources@chard-snyder.com.