Sr. Participant Services Representative

Title: Sr.

Participant Services Representative Department: Associated Administrators

FLSA: Non-exempt Hours per week: 40

Position Summary

The Sr.

Participant Services Representative provides customer service to participants, beneficiaries, union locals, and providers 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 written, verbal, or face-to-face customer service by 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 retirement and health and welfare benefits such as;
+ Processing and/or sending mailers or required forms as requested by members.
+ Processing and/or sending correspondence related to member or claims status.
+ Processing enrollments and updating member information in applicable system(s).
+ Distributing communications related to regulatory requirements.


* Initiates Action Requests to appropriate departments requesting adjustments to claims, retirement, and/or eligibility as necessary.

Follows up to ensure successful completion of Action Request.


* Researches and resolves complex and technical issues and irregularities.


* Performs other duties as assigned.

Minimum Qualifications


* High school diploma or GED.


* Three years of related work experience such as third-party administrator processing, benefits administration, or customer service in a health and welfare environment.


* 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, billing, or eligibility.



*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.

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 requ...