Participant Services Representative for Group Benefits Provider

Los Angeles, CA 90036 | Direct Hire

Job ID: MM-KO-BenClaRep01 Category: Professional Services Pay Rate: $35k/year

We are currently interviewing candidates for a Member Services Support Representative, Temp-to-Hire position, with our client’s busy group health benefits provider for members of the entertainment industry.

Our client provides vision, dental, psychiatric, medical and other healthcare benefits to members (and their dependents) of creative industries, including motion picture, television and commercial production. They are known for far reaching efforts that contribute to the general health and well-being of all its members. Our client also has a long history of charitable involvement in the community and encourages employees to volunteer time to their own special interests or those supported by the organization (such as The Actors Fund and Alzheimer’s research).

This role offers an exciting opportunity for motion picture and production aficionados to make a contribution to the industry they love by providing top customer support to the creative community seeking assistance with member services. Our client offers forward career momentum to those eager to grow with this company.

Ideal candidates bring 2+ years of benefits and healthcare customer support, 2+ years’ experience in claims processing and are known for their upbeat and helpful personality.

About the Position:

  • Answer benefits questions from plan members
  • Provide information to providers
  • Process medical, dental and vision claims
  • Manage the Express Scripts prescription program
  • Verify benefit coverage and status
  • Process vacation overrides and medication authorizations
  • Contact 3rd party vendors to facilitate support requests (pharmacies, providers)
  • Assist with claims payment issues
  • Research issues relating to payments, claims, benefits
  • Fax or reissue explanation of benefits to plan members
  • Provide updated information to claim examiners
  • Determine claims coverage using plan descriptions, medical reference books, guidelines
  • Data entry
  • Provide Claims and Eligibility forms
  • Provide information using digital systems (CRT)
  • Special projects as requested

About The Candidate:

  • 1+ years’ experience with group health insurance (PLUS)
  • 2+ years’ of college (PLUS)
  • 2+ years’ experience processing health claims (PLUS)
  • Intermediate computer skills including Word, Excel, Outlook (MUST)
  • Personality and Characteristics: great math skills, punctuality, "can-do" attitude, strong organizational skills, analytical, multi-tasker, interpersonal skills, team player, ability to prioritize, able to meet deadlines, able to work in fast paced environment, solid customer service skills

Equal Opportunity Employer considering qualified candidates in accordance with state and federal laws, including those with criminal histories, in a manner consistent with the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.

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