Employee Benefits Claims Consultant

Acrisure•Iselin, NJ

2d•Onsite

About The Position

The Claims Consultant (Public Entity) serves as a trusted client advocate and customer service resource for public sector clients, providing guidance and support throughout the employee benefits claims process. This role acts as the primary liaison between clients, carriers, TPAs, and internal Acrisure teams to ensure a positive claim experience, timely issue resolution, and exceptional service delivery. The Claims Consultant proactively addresses claim concerns, facilitates communication among stakeholders, educates clients on benefit processes, and supports the resolution of complex claim matters while building strong client relationships and promoting service excellence. As an experienced team member, the Claims Consultant also provides support to the Call Center Team on complexed claim situations with guidance on next steps.

Requirements

Bachelor’s degree in business or related field of study or equivalent experience required.
3 – 5 + years of experience in employee benefits administration, claims customer service, carrier operations, TPA services, account management, or employee benefits consulting.
Experience working with public entities (municipalities, school districts, counties, authorities, etc.) strongly preferred.
Experience working directly with insurance carriers, TPAs, healthcare vendors, or brokerage organizations preferred.
Active Life & Health Insurance License, or ability to obtain within 120 days of hire
Strong organizational skills- ability to prioritize and be proactive
Ability to adapt well to change in direction and priority in a fast-paced environment
Computer skills, specifically Microsoft Word, Outlook and Excel
Excellent verbal and written communication skills as well as strong interpersonal skills

Responsibilities

Provide proactive, technical consultative advice to public entity clients on employee benefits claim handling, trends, and outcomes.
Serve as the primary point of contact for clients regarding employee benefits claim questions, concerns, and service-related issues.
Deliver a high level of customer service by responding promptly to client inquiries and providing clear, professional guidance throughout the claim process.
Advocate on behalf of clients and members to facilitate timely claim resolution and ensure a positive service experience.
Educate clients on claims processes, benefit programs, coverage provisions, and available resources.
Assist clients and Call Center Team members in navigating routine and complex claims issues involving medical, dental, vision, disability, life, and related benefit programs.
Coordinate claim escalations with carriers and TPAs to facilitate timely resolutions.
Investigate claim concerns by gathering information, tracking progress, and communicating updates to clients.
Support appeals, grievances, and service-related claim challenges while maintaining a client-focused approach.
Document claim activity, action plans, and outcomes to ensure accurate records and follow-up.
Act as a liaison between clients, carriers, TPAs, and internal service teams to promote effective communication and seamless service delivery.
Foster strong working relationships with carrier representatives and vendor partners to help resolve client concerns efficiently.
Collaborate with account management and service teams to support overall client satisfaction and retention efforts.
Participate in client meetings and serve as a subject matter resource related service matters.
Coordinate periodic claim service reviews with clients, carriers, and internal stakeholders.
Assist in preparing claim summaries, service reports, and trend information to support client discussions.
Review claim service performance and identify opportunities to improve client experience and service delivery.
Monitor service commitments and ensure follow-through on action items and client concerns.
Provide training and educational support to clients regarding claims procedures, carrier requirements, and best practices.
Develop user-friendly resources and presentations to help clients better understand claim processes and available benefits.
Support internal education initiatives by sharing claims service trends, carrier updates, and client feedback.
Support customer service representatives with complex claims.
Identify opportunities to improve claims support processes, communication practices, and overall customer experience.
Provide feedback to carriers, TPAs, and internal teams regarding recurring service concerns and client needs.
Assist in developing best practices and service standards that enhance efficiency and client satisfaction.