We are seeking a Customer Service Representative to work for our non-profit client in the Mid-City area. This role offers a contract to hire employment opportunity. The ideal candidate will have strong customer service skills and will enjoy being on the phone and answering member questions. You will manage customer communication, process customer applications, and coordinate with providers to ensure accurate and efficient service.

Responsibilities:

• Answer and resolve inquiries from customers and their representatives regarding eligibility.

• Assist with the open enrollment process to ensure seamless customer experiences.

• Accurately adjust participant records, including adding, deleting, reinstating, and promoting dependents.

• Collaborate with health providers to update participants' and dependents' coverage.

• Manage the setup of coverage for various customer categories, including retirees, divorced and surviving spouses.

• Oversee the setup and monitoring of COBRA and self-pay coverage where applicable.

• Review and resolve discrepancies in customer accounts through vendor files.

• Follow up on various forms and verifications, including Affidavit of Surviving Spouse, Dependent Confirmation Forms, and Coordination of Benefits.

• Assist walk-in participants with eligibility-related matters and address their coverage questions.

• Compose and send out correspondence related to eligibility issues and required documents.

• Prepare and reconcile invoices to vendors for payment on a monthly basis.

• Process refunds due to overpayment or loss of coverage.

• Create tailored letters regarding eligibility information as needed.

• Review appeals related to late payment of premiums and late notice for adding dependents and for change of coverage plan

• Proficiency in using MS Excel, MS Outlook, and MS Word is mandatory.
• Experience in maintaining records accurately and efficiently.
• A demonstrable understanding of basic office skills is a must.
• Familiarity with the health insurance industry and its regulations is preferred.
• Excellent communication skills, both written and verbal, are required.
• Strong attention to detail and the ability to multitask effectively.
• Ability to work in a fast-paced and dynamic environment.
• Demonstrable problem-solving skills and the ability to make decisions independently.
• Prior experience in a similar role within the health insurance industry is desirable.
• Must have a high degree of integrity, professionalism, and confidentiality.
• Ability to work effectively both independently and as part of a team.
• Must have strong organizational skills and the ability to prioritize tasks effectively.
• Excellent customer service skills and the ability to handle customer queries and complaints professionally.
• Must be adaptable and flexible to changing business needs and requirements.
• Knowledge and understanding of eligibility criteria for health insurance is preferred.