Health & Welfare Benefits Advisor

Health & Welfare Benefits Advisor

The Health & Welfare Benefits Advisor educates members, providers, and health partners on how to navigate and utilize health and welfare benefit plans, while serving as a primary point of contact for inquiries and claim-related questions. This role focuses on benefits administration, customer service, and detailed claim processing, ensuring members fully understand and can access the benefits available to them.

Responsibilities:

• Educate members, providers, and health partners on how to navigate and effectively utilize health and welfare benefit plans.
• Respond promptly and professionally to member and provider inquiries, questions, and concerns regarding all health and welfare benefits.
• Coordinate with health partners to research and resolve member inquiries and concerns using health partner portals and related systems.
• Analyze and process member annual out-of-pocket maximum claim inquiries in accordance with plan provisions.
• Review and analyze member and provider claim inquiries to determine claim consideration and appropriate next steps.
• Process Accident and Sickness (Disability) claims, Supplemental Occupational Benefit claims, and member reimbursement claims accurately and within established guidelines.
• Manage all processes involving dependents, including adding dependents, disenrolling dependents, and updating records for changes in marital status.
• Assist with the set-up and ongoing handling of subrogation cases, ensuring proper documentation and coordination.
• Participate in member education initiatives related to the benefits package, including explaining coverage, procedures, and available resources.
• Maintain accurate records, documentation, and data within proprietary and partner systems to support benefit administration and claim processing.
• Communicate clearly and professionally in both verbal and written formats with members, providers, and internal partners.

Essential

Skills:

• Minimum of three years of experience in administration and/or benefits processing work.
• High school diploma or equivalent education.
• Demonstrated experience in benefits administration or closely related administrative functions.
• Strong customer service skills with the ability to handle inquiries and concerns in a professional and empathetic manner.
• Professional verbal and written communication skills suitable for interacting with members, providers, and health partners.
• Computer literacy with the ability to learn and use proprietary software and online portals.
• Ability to analyze claim inquiries and apply plan provisions accurately.
• Organizational skills to manage multiple inquiries, claims, and dependent-related processes simultaneously.
• Attention to detail in processing claims, updating member records, and maintaining documentation.

Additional Skills &

Qualifications:

• Prior experience with employee benefits plans, particularly health and welfare plans, is preferred.
• Familiarity or strong interest in health and welfare functions and Taft-Hartley labor management fund administration.
• Experience working with healthcare benefits and related administrative processes.
• Ability to collaborate effectively with health partners and internal teams.
• Interest in converting to a full-time role where applicable.

Work Environment:

This position is based on-site and follows a Monday through Friday schedule from 8:00 a.m. to 5:00 p.m. The role involves working with computer systems, proprietary software, and health partner portals in an office setting focused on benefits administration and member support. The environment supports professional communication, attention to detail, and collaboration with internal teams and external partners, offering the opportunity to transition to a full-time role.

Job Type &

Location:…