Accident & Sickness Representative

Position Summary

The Accident & Sickness Customer Care Advocate provides customer service to participants, beneficiaries, union locals, regarding eligibility, benefits, and claims status.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Duties and Responsibilities


* Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions.


* Provides verbal and/or in person customer service, responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.


* Updates files, including documenting system notes of conversations or action taken.


* Performs tasks associated with the administration of health and welfare benefits such as;
+ sending required forms as requested by members.


* Initiates Action Requests to department requesting stop pay, return to work, address change as necessary.

Follows up to ensure successful completion of Action Request.


* Researches and resolves complex calls.


* Performs other duties as assigned.

Minimum Qualifications


* High school diploma or GED.


* Six months of experience working in customer service, third-party administrator processing, or benefits administration.


* Strong work ethic and team player mentality.


* Highly developed sense of integrity and commitment to customer satisfaction.


* Ability to communicate clearly and professionally, both verbally and in writing.


* Solid organization skills with strong detail orientation and listening skills.


* Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.


* Proficient computer skills including MS Office tools and applications.

Preferred Qualifications


* Call center experience in benefits claims and multiple funds.


* Bilingual a plus.



*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job.

Duties, responsibilities and activities may change at any time with or without notice.

Working Conditions/Physical Effort


* Prolonged periods of sitting at a desk and working on a computer.


* Must be able to lift up to 15 pounds at times.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship.

The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process.

If reasonable accommodation is needed, please contact the Recruiting Department at recruiting@zenith-american.com , and ...