Participant Services Representative

Title

Participant Services Representative

Associated Administrators

Non-exempt

40

The Participant Services Representative provides customer service to participants, beneficiaries, union locals, and providers regarding eligibility, benefits, and claims status. The role has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) in accordance with the Job Description/Role.

• Maintain current knowledge of assigned Plan(s) and effectively apply knowledge in all job functions.
• Provide written, verbal, or face-to-face customer service by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.
• Update files, including documenting system notes of conversations or action taken.
• Perform 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.
• Process and/or send correspondence related to member or claims status.
• Process enrollments and update member information in applicable systems.
• Distribute communications related to regulatory requirements.
• Initiate action requests to appropriate departments requesting adjustments to claims, retirement, and/or eligibility as necessary.
• Follow up to ensure successful completion of action requests.
• Research and resolve complex and technical issues and irregularities.
• Perform other duties as assigned.

• 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.

• Call center experience in benefits claims, billing, or eligibility.

$19.00/hr

Health, vision, and dental coverage; a 401(k) retirement savings plan with company match; paid time off (PTO); and additional benefits as part of the total compensation package.

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 r

Zenith American Solutions is an equal opportunity employer and hires based on qualifications, merit, and experience.