Employer Service Rep - LHB

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.

Job Summary

Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

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.

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

Required Job Qualifications:

• 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

Preferred Job Qualifications:

• Bachelor’s degree

• Good presentation skills

• Experience presenting and explaining benefits to a group or one-on-one

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

EEO Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Pay Transparency Statement:

At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range:

$42,200.00 - $79,300.00

Exact compensation may vary based on skills, experience, and location.

Originally posted on Himalayas