Vacancy caducado!
Health Plans, Inc. (HPI) is a New England based Third-Party Administrator (TPA) of self-funded health and benefit plans. HPI was founded in 1981 to provide comprehensive health plan administration to employers, municipalities, and Taft-Hartley plans. Health Plans has grown to become an industry-leading TPA by offering customized self-funded benefit plans to employers, combined with superior customer service and investment in the latest administrative and data-mining technology, and reinsurance (stop-loss) security. Summary: In this position, the Plan Service Representative (PSR) will be engaged in both internal and external high-level service support, focusing on client issue resolutions. The PSR will provide technical and expedited service to assist our Account Management Team with resolving issues pertaining to claims, benefit questions, and eligibility matters. The PSR will have an in-depth knowledge of group health medical claims benefits, specifically in the self-insured markets. The successful candidate will take the lead to provide prompt, courteous, and accurate issue resolution for complex and escalated matters that a customer/broker/provider may have. The candidate will be required to collaborate and interface with various levels within HPI to resolve issues and provide timely, accurate results. Duties and Responsibilities (other duties may be assigned):
Handle through to resolution elevated customer service inquiries across differing product lines and functions to include knowledge of medical, dental, vision and disability claims payment, COBRA, stop loss, and eligibility.
Processes or adjust claims, to include requesting stop payments, voids, or overpayments when needed.
Proactively identifies and escalates any trends or payment issues and escalates immediately to both Operational and Account Management.
Makes recommendations for process improvement across business units. Helps develop and deliver training documentation and curriculum to improve operational effectiveness.
Works inter-departmentally to seek out information necessary to resolve customer issues; helps lead and facilitate inter-departmental work group meetings and participates in Claims Team meetings; and collaborates with internal teams to facilitate meeting deadlines.
Completes necessary reports or general correspondence related to client issues; tracks and documents all activities, decisions, and discussion points accurately.
Participates in Sales meetings, new product, new vendor, and internal client meetings as needed; attends and supports the Account Management Team on Open Enrollment Meetings or on client site visits, as needed.
Other additional duties, including special projects as assigned.
Education Requirements:
Associate degree or equivalent work experience
Experience Requirements:
5+ years of Customer Service experience and Claims Processing experience in a healthcare setting, including Third-Party Administrators, PPO/Fee for Service, HMO, Hospital Administration, fully insured carrier. Strong medical claims knowledge and understanding of health care industry standards
Proficient in Microsoft Office Suite including Word, Excel, Outlook, PowerPoint, and Teams
Why choose us?
Our space is a reflection of who we are—innovative, open and collaborative.
Love to get creative? We do too. Brainstorm in one of our team break-out rooms.
We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks.
Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.
Benefits
We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer to our employees:
Medical, Dental and Vision Coverage
Prescription Drug Coverage
Fitness Reimbursement Benefit
Tobacco Cessation Program
Employee Assistance Program
Flexible Spending Account & Health Savings Account
401(k) and Profit-Sharing Plan
Quarterly Bonuses
Generous Paid-Time Off
Volunteer Days
Education Assistance & Professional Development Opportunities
….and much much more!
So, think you want to join the HPI team? We hope to hear from you!
You can read more about us at hpitpa.com/about-us/careers/
EEO/AA/M/F/Vet/Disability Employer
Vacancy caducado!