Participant Services Representative
Job Description
Title: Participant Services Representative Department: Associated Administrators
FLSA: Non-exempt Hours per week: 40
Position Summary
The Participant Services Representative provides customer service to participants, beneficiaries, union locals, and providers regarding eligibility, benefits, and claims status.
"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."
Key Duties and Responsibilities
- Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions.
- Provides written, verbal, or face-to-face customer service by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.
- Updates files, including documenting system notes of conversations or action taken.
- Performs tasks associated with the administration of retirement and health and welfare benefits such as;
- Processing and/or sending mailers or required forms as requested by members.
- Processing and/or sending correspondence related to member or claims status.
- Processing enrollments and updating member information in applicable system(s).
- Distributing communications related to regulatory requirements.
- Initiates Action Requests to appropriate departments requesting adjustments to claims, retirement, and/or eligibility as necessary. Follows up to ensure successful completion of Action Request.
- Researches and resolves complex and technical issues and irregularities.
- Performs other duties as assigned.
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Minimum Qualifications
- High school diploma or GED.
- Six months of experience working in customer service, third-party administrator processing, or benefits administration.
- Strong work ethic and team player mentality.
- Highly developed sense of integrity and commitment to customer satisfaction.
- Ability to communicate clearly and professionally, both verbally and in writing.
- Solid organization skills with strong detail orientation and listening skills.
- Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.
- Proficient computer skills including MS Office tools and applications.
Preferred Qualifications
- Call center experience in benefits claims, billing, or eligibility.
*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.
Disability Accommodation
Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at recruiting@zenith-american.com, and we would be happy to assist you
union benefits
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Are you passionate about helping others and looking for a rewarding role in the customer service space? The Participant Services Representative at Associated Administrators might just be the perfect fit for you! In this position, you’ll serve as a vital link between participants, beneficiaries, union locals, and providers, answering questions about eligibility, benefits, and claims status. You'll leverage your strong communication skills to provide top-notch service through various channels—whether it's written, verbal, or in-person interactions. Your role will not only involve answering inquiries but also documenting every interaction to ensure transparency and efficiency. Plus, you’ll update member files, process enrollments, and handle correspondence related to claims status. With your attention to detail, you’ll research and resolve any complex issues that arise while following up on Action Requests, ensuring adjustments are made when necessary. You’ll need a high school diploma or GED and, preferably, experience in a call center or similar customer service role. A strong work ethic and a commitment to customer satisfaction are key in this position. If you’re looking for an environment that values teamwork and integrity, and are ready to dive into the world of retirement and health benefits, we’d love to hear from you!
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