Benefits Associate

LanguageLine Solutions•Mount Tabor, VT

About The Position

The Benefits Associate interfaces with internal and external resources to guide members through benefit plan options, costs, and detailed benefit reviews. The role answers incoming benefit calls and inquiries, follows up on issues that cannot be resolved during the initial contact, and provides objective support with open enrollment, new-hire elections, and changes in status. Associates connect with members by phone, build rapport, explain benefit choices, and provide exceptional customer service while following company policies, quality standards, and applicable laws and regulations. The position includes researching and resolving benefit issues through to completion, documenting cases, prioritizing work, monitoring trends, and escalating concerns to a supervisor when needed. It also requires maintaining confidentiality and professional relationships with members, colleagues, and other contacts. Work is mainly in an indoor office environment and is sedentary, involving continuous computer, telephone, and printer use, as well as ongoing reading, concentration, and verbal and written communication.

Requirements

High school degree or GED required.
At least one year of customer service, healthcare, or employee benefits experience required.
Basic knowledge of Microsoft Word and Excel required.
Must score acceptably on job-related testing and pass a standardized interview.
Strong communication skills and phone etiquette.
Ability to explain complex issues to members.
Highly effective listening skills.
Strong problem-solving and issue-resolution skills.
Excellent customer service and customer-resolution skills.
Strong organizational and administrative skills.
Ability to work in a team environment.

Nice To Haves

Associate degree from an accredited college or university, with coursework in business administration, liberal arts, public health, healthcare management, or a related field.
Time spent pursuing a bachelor’s degree, such as junior or senior year, may be substituted for experience requirements.
Depending on assignment, bilingual ability such as English and Spanish may be needed.
Knowledge of COBRA.
Knowledge of Medicare A and B, Medigap, supplement plans, Medicare Advantage, and Medicare Part D.
Knowledge of high-deductible health plans, including Health Reimbursement Accounts and Health Savings Accounts.
Knowledge of flexible spending accounts, including limited FSAs.
Knowledge of coordination of benefits and identifying the primary plan in simple cases involving commercial or Medicare plans.
Knowledge of Summary Plan Documents and Certificates of Coverage.
Knowledge of government programs, resources, legislation, and mandates, including the Affordable Care Act, FMLA, Medicaid, and CHIP.
Knowledge of fully insured and self-insured group health plans.
Knowledge of pharmacy benefits, including injectable medications.
Knowledge of individual health plans and Marketplace or exchange plans.

Responsibilities

Guide members on benefit plan options, cost factors, and detailed benefit reviews while following departmental and corporate policies.
Answer incoming calls and cases, respond to member benefit inquiries, and place outbound follow-up contacts when issues cannot be resolved during the initial interaction.
Provide objective information about benefit options during open enrollment, new-hire election periods, and changes of status, including comparing and contrasting plans.
Build rapport with members by phone and help them navigate benefit choices and options.
Answer questions about medical, dental, pharmacy, vision, life, short- and long-term disability, consumer-driven health plans, FSAs, provider selection, qualifying life events, enrollment, and estimated care costs.
Review options and costs for individual health insurance, Marketplace or exchange plans, COBRA, and Medicare plans.
Process calls in accordance with established policies, procedures, quality standards, and applicable laws and regulations.
Protect employee health information and maintain strict confidentiality in accordance with applicable privacy requirements, including HIPAA and COBRA.
Identify, research, and resolve benefit issues in a timely manner, following each issue through to resolution.
Thoroughly document benefit issues and maintain departmental files and system records.
Evaluate and prioritize work to provide timely, quality service.
Monitor issue trends and escalate them to a supervisor to support corrective action and service improvements.
Maintain professional relationships with internal and external customers, team members, and department contacts; cooperate with team members and provide respectful, quality service.
Escalate situations outside the employee’s control that could adversely affect service.
Perform other duties as assigned.