Member Benefits Specialist

Call Center - Member Benefit Specialist

Base pay range: $48,000.00/yr - $50,000.00/yr

As a Member Benefit Specialist you will assist policy holders, providers and agents with their health insurance inquiries and concerns over the phone. Your duties will include answering questions about coverage, claims, benefits and resolving billing issues. This role requires the ability to maintain accurate records of customer interactions in a high volume call center while maintaining a professional demeanor and providing excellent customer service.

• Ability to read, understand, and communicate medical benefits according to SPD language;
• Respond to inquiries and phone calls from providers, policyholders, and agents regarding benefits, coverage, or claims status in accordance with established performance expectations;
• Maintain quality customer services through call center; follow customer service practices; adhere to timely expectations according to established expectations;
• Comfortable placing outbound calls for request and follow-up on additional information as needed for incomplete claims, to include but not limited to COB, accident investigations, eligibility, etc.;
• Familiar with and understands various fee schedules

• Knowledge of TPA administrative services, policies, procedures and systems;
• 6 months+ of customer service call center experience in medical insurance environment addressing member and provider calls;
• Dental and Vision benefit knowledge a plus;
• Excellent verbal, communication, and written skills with strong organizational and research skills;
• Proficiency in Microsoft Office (Word, Excel and Access);
• Must be detail-oriented, have ability to work well under pressure, and handle multiple tasks with deadlines;
• Bilingual (English/Spanish) skills a plus.

• Medical, dental and vision benefits
• Annual bonus
• Dependent care 100% match up to max allowable
• PTO beginning on Day 1
• Tuition reimbursement
• Health work/life balance
• Hybrid office schedule
• 401(k) plan with company match
• Employee Assistance Program
• On-site gym with personal trainer access
• Life insurance and short term disability insurance

Headquartered in Rocky River, Ohio, Roundstone is regularly recognized as a Northeast Ohio Top Workplace by the Plain Dealer and  We are especially proud to be recognized as a Top Workplace since this honor is determined by anonymous feedback from our own employees. Roundstone employees enjoy a supportive workplace where they are engaged, valued and regularly recognized for their hard work at monthly company meetings.

Roundstone’s core values are evident every day and are shared with the community through the sponsorship of community events and outreach.

• Live well:
  Be healthier and bring positive energy to all you do.
• Work smarter:
  Get things done, better.
• Own it:
  Accountability is your middle name. Be on time, do what you say, and finish what you start.
• Be intellectually curious:
  Always be learning. See opportunity everywhere and have a drive to know.

Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey: (Use the "Apply for this Job" box below). R5f Ly Uj . Don’t meet every single requirement? At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways.

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