Benefits Customer Service Representative

Ccmsi • Metairie, LA

5d • Onsite

About The Position

The Benefits Customer Service Representative serves as a primary point of contact for members, healthcare providers, insurance carriers, and internal team members regarding group health benefits, eligibility, claims processing, and coverage questions. This position plays a vital role in delivering exceptional customer service while ensuring members receive accurate information and timely assistance. The successful candidate will interpret benefit plan provisions, research claims issues, support appeals processes, and collaborate with internal teams and external partners to resolve benefit-related concerns. This role is ideal for someone with health insurance, medical billing, claims processing, benefits administration, or healthcare customer service experience who enjoys helping people navigate complex benefit questions.

Requirements

• High School Diploma or equivalent
• Medical terminology knowledge required
• Minimum two years of experience in one or more of the following: Health insurance, Benefits administration, Health claims processing, Medical billing, Customer service within a healthcare environment
• Strong verbal and written communication skills
• Strong organizational and time-management skills
• Ability to research and resolve benefit and claim issues
• Ability to manage multiple priorities and deadlines
• Strong attention to detail and accuracy
• Ability to maintain confidentiality and professionalism
• Proficiency with Microsoft Office applications, including: Outlook, Word, Excel
• Reliable attendance during scheduled business hours
• Ability to speak to groups of 20-100 attendees for presentations

Nice To Haves

• Associate degree
• Experience interpreting health plan documents and benefit structures
• Experience with medical claims billing, payment, and posting
• Experience handling benefit appeals
• Knowledge of medical coding
• Experience supporting governmental or public entity benefit programs
• Prior benefits customer service experience

Responsibilities

• Answer and manage incoming calls related to health benefits, eligibility, claims processing, and coverage questions
• Serve as a primary resource for members, providers, insurance carriers, and other authorized parties
• Interpret benefit plan documents, summaries of benefits, and coverage provisions
• Explain eligibility, deductibles, copayments, exclusions, limitations, coordination of benefits, subrogation, and claim procedures
• Research claim status inquiries and determine whether claims were processed appropriately
• Assist with claim denials, payment questions, appeal requests, and benefit explanations
• Respond to written inquiries related to benefits, eligibility, claims processing, appeals, and coverage questions
• Research, document, and process appeals in accordance with plan provisions and established deadlines
• Coordinate with internal staff, medical reviewers, providers, and insurance carriers to resolve member concerns
• Support annual enrollment activities and enrollment meetings for participating groups
• Provide backup support to other benefits team members as needed
• Maintain accurate documentation and records within company systems
• Ensure compliance with privacy and confidentiality requirements, including handling protected health information appropriately

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy)
• 10 paid holidays in your first year
• Medical, Dental, Vision, Life, and Disability Insurance
• 401(k) and Employee Stock Ownership Plan (ESOP)
• Internal training and advancement opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED