Serve as a primary contact for assigned employer groups regarding benefits administration and service inquiries
Respond to employer, broker, and member requests via phone, email, and ticketing systems within established service standards
Educate employer groups on TPA processes, policies, eligibility rules, and available services
Build and maintain positive working relationships with clients and brokers
Coordinate with claims, provider relations, and stop-loss departments to resolve escalated issues
Research claim status inquiries and facilitate timely resolutions
Track and document service issues to ensure follow-through and client satisfaction
Maintain confidentiality and ensure compliance with HIPAA and company policies
Document client interactions and account activity accurately within internal systems
Support audit requests and reporting needs as required
Participate in employer implementations and renewals
Identify opportunities for process improvement and enhanced client experience
Support special projects and cross-functional initiatives as assigned

High school diploma or equivalent required; associate or bachelor's degree preferred
2+ years of customer service or account management experience in healthcare, insurance, benefits administration, or TPA operations
Experience in a self-funded health plan or TPA environment preferred
Knowledge of ERISA, COBRA, HIPAA, and ACA requirements preferred
Experience working with brokers, employer groups, and carrier partners
Working knowledge of group health benefits, eligibility, claims processing, and billing practices
Proficiency in Microsoft Office Suite and ability to learn multiple administrative systems
Strong attention to detail and organizational skills
Clear and confident communication skills for both internal and external customers.

Employer Service Representative

Key skills