Senior Participant Service Specialist (with Health Ins Experience)
Burbank, CA 91505 | Direct Hire
We seek a Member Services Representative with Health Insurance Industry experience for a position at 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 as well as pension plans 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.
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 4+ years of benefits and healthcare customer support, 2+ years’ experience in claims processing and are known for their upbeat and helpful personality. Individuals with direct health insurance company experience, specifically Medicare, PPO and/or HMO plans are strongly encouraged to apply.
About the Position:
- Provide top-notch customer service
- Answer benefits questions from plan members
- Provide product and service information
- Identify needs of caller to provide solutions and information
- Ask appropriate questions and listen actively
- Document customer interactions in computerized tracking system
- Update call logs
- Track requests from start to resolution
- Interpret and clarify issues
- Research issues relating to payments, claims, benefits
- Research and explain options
- Provide updated information to claim examiners
- Review incoming healthcare claims using multiple computer systems and platforms
- Verify benefit coverage and status
- Determine claims coverage using plan descriptions, medical reference books, guidelines
- Ensure correct benefits are applied to claims
- Process medical, dental and vision claims
- Process complains
- Assist with claims payment issues
- Adhere to established procedures, federal mandates, CMS/Medicare guidelines, etc
- Data entry
- Contact 3rd party vendors to facilitate support requests (pharmacies, providers)
- Provide Claims and Eligibility forms
- Special projects as requested
This is not a comprehensive list of duties.
About the Candidate:
- 4+ years’ experience with claims processing (MUST)
- 2+ years’ experience healthcare call center (MUST)
- 2+ years’ experience explaining plans, benefits and policies (MUST)
- Intermediate computer skills including Word, Excel, Outlook (MUST)
- Personality and Characteristics: "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, excellent time management
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.