Benefits Customer Service Analyst

Western & Southern Financial Group-posted 3 months ago

Cincinnati, OH

251-500 employees

Securities, Commodity Contracts, and Other Financial Investments and Related Activities

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The position involves answering inquiries primarily through telephone communications while providing a high level of quality customer service. The role includes preparing pre-notification documentation for medical procedures and various prescription drugs, maintaining benefit eligibility information for associates and retirees across multiple systems, and ensuring compliance with Plan provisions, department policies, and Department of Labor regulations. The individual will work with minimal supervision, making decisions within an established range and escalating issues to the Manager as necessary.

Answers associate and health care providers' requests over the telephone or through written correspondence within the time service standards set by the department.
Exercises excellent customer service skills ensuring each contact is a positive experience by using a professional tone, displaying empathy as appropriate, being sincere and practicing good listening skills.
Uses sound judgment when confronted with an unusual or unfamiliar request.
Administers the Open Enrollment process involving communication with all Home Office and Field associates as well as all retirees to maintain or change their benefits for the upcoming plan year.
Obtains medical information from associates, hospitals and doctors for pre-existing, outpatient/inpatient preauthorization reviews, second opinion determinations and concurrent reviews for inpatient admissions.
Creates and updates nurse record screen on the benefits claim system including all medical information obtained from the member, hospital and physician offices.
Creates and maintains benefit information for each associate, retiree and eligible family members in multiple systems used in the Benefits Department.
Administers the prescription drug program.
Maintains override information on all preauthorized prescriptions.
Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality, and protection of personal information.
Performs other duties as assigned.
Complies with all policies and standards.

High School Diploma Or GED (Required)
Demonstrated experience maintaining a calm and professional demeanor when handling difficult and sensitive situations with callers (Required)
Demonstrated experience working as part of a team developing cooperation and collaborative work efforts toward solutions that benefit all parties involved (Required)
Proven experience completing multiple assignments simultaneously, and completing assigned tasks accurately and on a timely basis.
Must demonstrate strong attention to detail with excellent organizational skills (Required)
Proven success working in a high-volume call center as a service rep identifying customer issues, defining and resolving problems, and collecting or interpreting data to establish facts, draw valid conclusions and provide effective resolutions.
Demonstrated excellent verbal and written communication skills with ability to convey information, verbally and in writing, to internal and external customers at all levels in a clear, accurate, focused and concise manner.
Demonstrated ability to document procedures and activities in a manner that is understandable to others and prepared using a prescribed format.
Proven ability to handle confidential information in a discreet manner.
Working knowledge of word processing and spreadsheet applications.

Proven ability to handle confidential information in a discreet manner.

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