Job Details

The Benefit & Claims Service Specialist plays a crucial role in providing essential information regarding health and welfare, benefits, and claim status to hospitals, providers, and participants. This position emphasizes delivering exceptional customer service while efficiently documenting inquiries—whether through phone, written communication, or in-person visits—about benefits or claim statuses in a friendly and professional manner.

Responsibilities
Customer Service

• Deliver outstanding customer service by promptly documenting and addressing inquiries from members concerning benefits and claim statuses in a professional manner.
• Effectively respond to and resolve complex issues, including those escalated from members.
• Act as the primary daily contact for clients to ensure reliable service delivery.
• Resolve inquiries related to intricate plan provisions and address any challenges encountered.
• Communicate relevant issues to the Team Supervisor or Department Manager as needed.
• Embrace and utilize professional excellence tools and concepts to enhance service delivery and efficiency.

Teamwork

• Collaborate effectively with fellow team members to achieve shared goals.
• Actively engage in team meetings and training sessions to foster personal and team growth.
• Take on additional responsibilities and projects as assigned by management.

Education/Certification:

• High School Diploma or GED (minimum requirement).

Skills/Abilities:

• Typing proficiency of at least 40 WPM and 3,000 KPH.
• Experience in a medical setting, such as a doctor's office or hospital billing, is beneficial.
• Familiarity with medical terminology is advantageous.
• Maintain up-to-date knowledge of plan benefits to provide accurate information to participants and providers.
• Demonstrate a professional and client-focused demeanor towards colleagues and tasks.
• Possess strong oral and written communication skills, with a keen attention to detail.
• Exhibit a proactive approach to seeking learning opportunities and perspectives.
• Show a strong commitment to completing all tasks and assignments.
• Ability to sit for extended periods while operating a computer keyboard.
• Bilingual skills in English and Spanish are preferred.

Employee Benefits Program

COMPANY PROVIDES:

• MEDICAL, DENTAL, VISION
• SHORT-TERM DISABILITY
• Affordable weekly premium: $5 for Employee Only, $15 for Child(ren), $20 for full family or Employee/Spouse.
• COMPANY PAID supplemental dental coverage of $1,000 annually for Employee.
• COMPANY PAID Long-Term Disability & Life/AD&D coverage.
• 401K Plan with company match up to 5%.
• COMPANY FUNDED additional pension plan.
• EXCEPTIONAL TIME OFF package, including Paid Personal Leave and Vacation with buy-back options!
• Annual, automatic pay increases offered.

Southwest Service Administrators is committed to providing equal employment opportunities to all employees and applicants, without regard to race, color, religion, sex, national origin, pregnancy, military and veteran status, age, physical and mental disabilities, genetic characteristics, or any other unlawful consideration. This policy applies to all aspects of employment, including recruiting, hiring, placement, promotion, termination, layoffs, recalls, transfers, leaves of absence, compensation, and training. We strictly prohibit any form of workplace harassment based on these characteristics.