Summary – The Healthcare Benefit Specialist will serve as a knowledgeable and resourceful benefits expert, empowering members to navigate their plans with confidence and ease. Actively listen to inquiries, research, and resolve complex issues, and provide accurate and timely information while ensuring efficient data management. Utilize strong analytical and critical thinking skills to make using their benefits easier for members and to streamline communication with BeneSys, fostering positive relationships and improving overall member satisfaction.
Essential Duties include but not limited to
Member Support
- Provide exceptional member support via phone calls, walk-ins, and emails related to enrollment and healthcare benefits.
- Assist members in navigating their healthcare benefits effectively by resolving inquiries and addressing concerns as the BeneSys primary point of contact. Questions could be related to deductibles, out of pocket accumulators, medical, prescription and disability benefits.
- Provide accurate and timely information to members regarding their healthcare benefits through active listening and effective communication.
- Utilize strong analytical and critical thinking skills to research and resolve complex eligibility and healthcare benefit inquiries.
- Communicate with vendors/carriers on behalf of the member regarding eligibility issues.
Data Entry and Enrollment
- Ensure accurate enrollment processing by collecting enrollment forms and self-payments, adding members and dependents to systems, and verifying documentation.
- Maintain member data integrity by updating records, processing month-end reports, and resolving discrepancies.
- Streamline benefit access by preparing enrollment packages, issuing ID cards, and notifying members of qualifying events.
- Possess a thorough understanding of plan rules outlined in the Summary Plan Description to answer member inquiries accurately and provide informed guidance regarding eligibility.
- Use month-end reports to determine eligibility, reinstatement, and termination of health care coverage.
- Ensure accurate and timely enrollment by processing monthly reports and distributing enrollment packages, COBRA information and self-payment bills efficiently.
- Create Claim Action Form (CAF) for claim resolution and completing all CAF assigned to their attention.
Required Experience and Qualifications
- Experience in a fast-paced environment with proven ability to manage high call volume and prioritize tasks effectively.
- Demonstrated success in resolving inquiries and complaints while exceeding customer satisfaction standards.
- Effective communication skills both written and verbal, with the ability to convey complex information clearly and concisely to diverse audiences.
- Empathy and active listening skills to understand member concerns and provide reassurance and emotional support.
- Proven ability to build rapport and establish trust with members, creating positive relationships.
- Problem-solving and analytical abilities.
- Empathy and emotional intelligence.
- Excellent research and investigative skills.
- Background in healthcare a plus.
- Passion for advocating for others and making a difference.
- Leadership skills.
- Regular and predictable attendance is an essential function of this job.
Preferred Experience and Qualifications
- Familiarity with basic medical types of health insurance plans.
- Experience in a customer service role, ideally within the healthcare industry is preferred.
- Experience handling complex issues or working with diverse populations can be an advantage.
- Supervisory experience is a plus.
- Candidates with experience leading and motivating teams will be given strong consideration.
Impact - The Healthcare Benefit Specialist will have a profound impact on the lives of members. You will be more than a Healthcare Specialist; you will be a healthcare hero, resolving eligibility issues and translating complex plan rules and benefits into clear, concise language, ultimately improving the lives of members during their most challenging moments.
Work Environment - Fast paced environment. Must be able to work independently as well as in a team. Must be able to multi-task and be detail oriented.