Employer Service Rep - LHB

Luminare Health

1d•Remote

About The Position

At Luminare Health, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. This position supports Tribal ESR operations and serves a highly visible Tribal customer group. Candidate must demonstrate the ability to provide a consistently high level of service, professionalism, and responsiveness to meet the service expectations and unique needs of Tribal business partners. This position is responsible for working with external customers to resolve claim and customer service issues initiated by clients or Client Management. Responsibilities include research and resolution of issues; recommendations for improvement of processes and procedures to eliminate recurrence of issues or to prevent future issues; communication with clients, Operations and Client Management; and tracking/monitoring of issues. This position may not service all clients.

Requirements

Tribal experience required
High School diploma or GED equivalent
Minimum five or more years claim processing/health insurance industry experience
Ability to work in a fast-paced, customer service driven environment
Excellent verbal and written communication skills
Ability to research various topics, succinctly summarize findings and develop a recommendation
Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff
Solid understanding of ERISA and DOL regulations
Ability to read, analyze and interpret documents and Summary Plan Descriptions (SPDs)
Flexible; open to continued process improvement
Self-directed individual who works well with minimal supervision
Good leadership, organizational and interpersonal skills
Demonstrated critical thinking skills
Ability to effectively deal with problems in varying situations and reach resolution
Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word

Nice To Haves

Bachelor’s degree
Good presentation skills
Experience presenting and explaining benefits to a group or one-on-one

Responsibilities

Research and resolve claim issues initiated by clients and/or brokers.
Provide timely written or verbal status updates and explanations to clients, brokers or Client Management regarding issues.
Follow-up regularly on outstanding issues to ensure timely resolution and client satisfaction.
Appropriately notify, refer or escalate issues.
Track issues and document resolution.
Provide issue reports to Claims & Customer Management and Client Management on a regular basis.
May also provide periodic reports to clients.
Recommend process, procedure or other actions to eliminate reoccurrence of issues or prevent future issues.
Develop and maintain good relationships with select clients, Client Management and Claims & Customer Service personnel.
Assist with benefit fairs or benefit meetings.
Complete special client requests or projects, as directed.
Other duties as needed/assigned.