ERC Benefit Specialist

Higginbotham•Fort Worth, TX

6h•Onsite

About The Position

The Employee Response Center (ERC) Benefits and Claims Specialist is a key role in the Financial Services Day 2-ERC Department at Higginbotham. The role is responsible for ensuring a thorough knowledge of claims, research tools, and resources to serve employees and employers effectively. This role is centered around evaluating and reviewing claims with precision and accuracy. The individual must be meticulous to determine the claims’ validity and ensure that insurance carriers’ payments are made per policy terms and regulatory requirements. The ERC Benefits and Claims Specialist will also support as backup to the ERC Benefits Specialists, take employee calls, and respond to emails and texts as needed during non-peak and peak times.

Requirements

5+ years of employee benefits, insurance experience, claims-carrier knowledge, and customer service in business/industry experience required
Proficient understanding of employee benefit plans and their operations, claims, carriers, and provider relations, including contract interactions
Knowledge of employee benefits, COBRA administration, and insurance products
Active General Lines Insurance License required
Proficient with Microsoft Excel, Word, PowerPoint, and Outlook

Nice To Haves

Bilingual / Spanish preferred
Applied Epic experience preferred, but knowledge of similar Account Management System (AMS) is acceptable
Additional license and certifications for advising employees on insurance products preferred

Responsibilities

Maintaining documentation, spreadsheets, products, and services as requirements change
Serving as a subject matter expert on reviewing and assessing insurance claims, analyzing documentation, calculating benefit payments, liaising with claimants and insurance agents, utilizing specialized software, interpreting policy coverage, negotiating settlements, and providing expert testimony
Drive continuous process improvements and create the claim/customer service process, training documentation, and manual
Assisting Account Managers/Producers in the setup and maintenance of required Claim Services
Assist in creating/Writing Standard Operating Procedures (SOP)
Answer and advise clients (employees, retirees, and dependents) regarding their benefit plans as appropriate.
Research questions and issues as necessary, including discussion with appropriate Carriers and Producer Teams
Assist with client (employees, retirees, COBRA participants, dependents) enrollment into the appropriate enrollment tool (paper or electronic)
Log all activity into designated software for reporting purposes. (Document all calls and emails and comments in EPIC)
Ensure that all client requests (calls, voicemails, emails, etc.) are answered within 3 business hours. (i.e. voicemail is left at 5:00pm on Friday, call must be returned by 11:00am on Monday)
Return employee, client, and Account Manager phone calls and emails promptly
Enroll employees according to their current enrollment systems
Answer benefits, HR, and claims-related calls as needed by clients
Assist with COBRA Administration as needed
Build and maintain processes and templates (with Management assistance) to complete tasks more efficiently and effectively
As time allows, assist and cross-train on other team functions
Assist with marketing Higginbotham’s products and services to clients and prospects as requested