Employee Benefits Claims Consultant

Role Overview

• Provide proactive, technical consultative advice to public entity clients on employee benefits claim handling, trends, and outcomes
• Serve as the primary point of contact for clients regarding employee benefits claim questions, concerns, and service-related issues
• Deliver a high level of customer service by responding promptly to client inquiries and providing clear, professional guidance throughout the claim process
• Advocate on behalf of clients and members to facilitate timely claim resolution and ensure a positive service experience
• Educate clients on claims processes, benefit programs, coverage provisions, and available resources
• Assist clients and Call Center Team members in navigating routine and complex claims issues involving medical, dental, vision, disability, life, and related benefit programs
• Coordinate claim escalations with carriers and TPAs to facilitate timely resolutions
• Investigate claim concerns by gathering information, tracking progress, and communicating updates to clients
• Support appeals, grievances, and service-related claim challenges while maintaining a client-focused approach
• Document claim activity, action plans, and outcomes to ensure accurate records and follow-up
• Act as a liaison between clients, carriers, TPAs, and internal service teams to promote effective communication and seamless service delivery
• Foster strong working relationships with carrier representatives and vendor partners to help resolve client concerns efficiently
• Collaborate with account management and service teams to support overall client satisfaction and retention efforts
• Participate in client meetings and serve as a subject matter resource related service matters
• Coordinate periodic claim service reviews with clients, carriers, and internal stakeholders
• Assist in preparing claim summaries, service reports, and trend information to support client discussions
• Review claim service performance and identify opportunities to improve client experience and service delivery
• Monitor service commitments and ensure follow-through on action items and client concerns
• Provide training and educational support to clients regarding claims procedures, carrier requirements, and best practices
• Develop user-friendly resources and presentations to help clients better understand claim processes and available benefits
• Support internal education initiatives by sharing claims service trends, carrier updates, and client feedback
• Support customer service representatives with complex claims
• Identify opportunities to improve claims support processes, communication practices, and overall customer experience
• Provide feedback to carriers, TPAs, and internal teams regarding recurring service concerns and client needs
• Assist in developing best practices and service standards that enhance efficiency and client satisfaction

Requirements

• Bachelor’s degree in business or related field of study or equivalent experience required
• 3 – 5 + years of experience in employee benefits administration, claims customer service, carrier operations, TPA services, account management, or employee benefits consulting
• Experience working with public entities (municipalities, school districts, counties, authorities, etc.) strongly preferred
• Experience working directly with insurance carriers, TPAs, healthcare vendors, or brokerage organizations preferred
• Active Life & Health Insurance License, or ability to obtain within 120 days of hire
• Strong organizational skills
• ability to prioritize and be proactive
• Ability to adapt well to change in direction and priority in a fast-paced environment
• Computer skills, specifically Microsoft Word, Outlook and Excel
• Excellent verbal and written communication skills as well as strong interpersonal skills

Benefits

• Comprehensive medical insurance, dental insurance, and vision insurance
• Life and disability insurance
• Fertility benefits
• Wellness resources
• Paid sick time
• Generous paid time off and holidays
• Employee Assistance Program (EAP)
• Complimentary Calm app subscription
• Immediate vesting in a 401(k) plan
• Health Savings Account (HSA) and Flexible Spending Account (FSA) options
• Commuter benefits
• Employee discount programs
• Paid maternity leave and paid paternity leave (including for adoptive parents)
• Legal plan options
• Pet insurance coverage