SAG-Producers Pension and Health Plans

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Participant Service Representative (Health Insurance Benefits)

at SAG-Producers Pension and Health Plans

Posted: 9/24/2019
Job Status: Full Time
Job Reference #: 48b6073b-69c6-406c-990a-525fa62ce02c

Job Description

Essential job functions

  • Responds to telephone inquiries regarding plan benefits, medical claim status including correspondence and payment, eligibility, pension, coordination of benefits, earnings, premium information, and Plan website inquiries
  • Documents all calls handled
  • Creates workflows to the Claims department and other business units
  • Requests applicable correspondence for providers and participants. Examples include but are not limited to: benefits, eligibility, pre-authorizations, and order of benefits
  • Follows up on outbound calls and open CRM system contacts
  • Processes requests for notice of eligibility, check tracers, forms or booklets
  • Emails participants and providers
  • Participates in QA coaching sessions
  • Participates in training sessions and departmental meetings as required


Knowledge, Skills & Abilities

  • Basic medical terminology is required
  • CPT, ICD10, HCPCS codes, and COB rules
  • General PC Computer skills, specifically in Microsoft Outlook, Word, and Excel
  • General Internet experience
  • Ability to manage all callers and situations in a professional, tactful, and courteous manner
  • Ability to quickly acquire the knowledge of the Plan’s various retirement, health plans and other insurance plans
  • Ability to quickly acquire the knowledge to use a variety of Plan system applications
  • Ability to listen and ascertain the needs of the caller
  • Ability to handle multiple interruptions and adjustments to priorities throughout the day
  • Ability to maintain confidentiality
  • Ability to maintain a QA percentage of 95%
  • The ability to multi-task, including documenting the system during a call