Health Benefit Officer II
Summary: Handle incoming calls and correspondence from customers in a call center environment. Provide accurate detailed responses to their inquiries and move issues to a successful resolution based on the benefits outlined in the Plan's Brochure.
This position requires a minimum of 90% of work time to be on the phones.
Duties and Responsibilities include the following. Other duties may be assigned.
- Appropriately service customer regarding benefits, service and medical care issues. Provide timely and accurate information to incoming calls, emails and written correspondence from customers regarding claim status and health benefits. *
- Ensure that complaints & appeals are processed in accordance with regulations, compliance standards, policies and procedures. *
- Process customer address changes, claims inquiries and faxes according to established departmental policies and procedures. Work closely with business partners to resolve customer issues
- Prepare various benefit letters for customers.
- Identify and elevate appropriate issues to the supervisors/management staff
- Route claims requiring an adjustment to the Plan's administrator and ensure all relevant information needed to reach a successful outcome is provided.
- Completely and accurately, document all interactions necessary to handle customer issues in an accurate and timely manner. *
- Follow up with customers as needed to update them on the progress of open issues and the resolution of closed issues in a timely manner. *
- Process letters and faxes received within 48 hours.
- *Return customer calls within 24 hours. *
- Other Duties as assigned.
To perform this job successfully, an individual must complete the AFSPA training program within 90 days of their hire, achieve at least a minimum passing score of 85% on ALL exams and maintain an acceptable level of quality. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
High School Diploma or equivalent; minimum of two years of health-related customer service experience or one year of health customer service AND two years of other customer service.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
To perform this job successfully, an individual should have knowledge of Microsoft Word; Internet Explorer; database software and Microsoft Outlook.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands; reach with hands and arms and talk or hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to ten pounds. Specific vision abilities required by this job include close vision.
Compensation for this position is in the high $30k range to mid $40k range depending on qualifications and experience.
AFSPA is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity and Affirmative Action Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class.
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