- Entry level
- No Education
- Salary $15.00 - $17.00 gross per hour
A large health insurance company is seeking a Health Plan Specialist to join their growing team
There is potential for FTE conversion for top performing contractors after the assignment is complete.
· Supports individual and family Group coverage.
· Works with active, terminated, and prospective members.
· Acting as the primary contact for members to resolve service problems for claims, enrollment, billing, pharmacy as well as interpreting contracts and explaining benefits.
· Communication between internal and external customers-External customers include the following: active, terminated, and prospective customers (providers and third-party administrators). Internal customers include: employees in medical management, enrollment, billing, claims, sales/marketing and legal. Outside vendors may include: pharmacy benefits managers, behavioral health and dental providers.
· Providing service satisfaction, providing quality service, and the service recovery process.
· The Health Plan Specialist II will use this process to assist members in complex situations.
· Treat members with respect and courtesy and always act with the customer in mind
· Represent the organization to the customer in a detail oriented manner
· Work efficiently by utilizing online tools and resources
· Resolve customer issues with a high degree of accuracy and timely follow-up to maintain customer trust and satisfaction
· Identifying, researching and resolving member and all other internal and external customer concerns, problems and issues in a timely and courteous manner.
· Work with enrollment, billing and other departments to resolve member issues.
· Provide end-to-end resolution of all issues by maintaining ownership and retaining all documentation to ensure complete, accurate, and timely resolution.
· Able to work independently while thinking critically and have the ability to problem-solve
Advancement opportunities are moderate to high! After mastering the claims, pharmacy and benefits skill sets within this position and performing at above standard levels, the Health Plan Specialist II could move into higher Health Plan Specialist tiers. From there, the Health Plan Specialist could move into a Lead, Issue Resolution Analyst, Client Specialist, Quality Administrator, Consumer Affairs Advisor or supervisory position within the department or other departments. Manager positions may be available in Customer Service, Provider Service Center, Special Investigations Unit, Claims Analysis and Recovery, Electronic Commerce and Project Management. A technical route may include IT Service Desk, Business Analyst and Electronic Commerce Specialist positions.
• 1-2 years customer service experience required
• Associate’s degree or equivalent work experience required. Bachelor’s degree preferred.
• Team interaction and support of each other in dealing with customer issues.
• Advanced ability to multi task and manage time efficiently
• An ability to identify process improvements
• Provide mentor and peer feedback
• Develop knowledge of multiple products and platforms
• Demonstrated ability to learn quickly and respond well to a rapidly changing industry and operational environment
• Excellent verbal and written communication skills
For immediate consideration please send an e-mail with your resume and any other supporting documents tol Olivia.Oster@officeteam.com
- customer service
- ms project
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