** Customer Service Representative**

**Job Category****:** First Insurance Group **Requisition Number****:** CUSTO002939 Showing 1 location **Job Details**

**Description**

****Position Title:** Customer Service Representative**

****Department:** First Insurance Group Employee Benefits**

****Position Reports to:** Vice President, Employee Benefits**

****Position Supervises:** No Direct Reports**

****Position Summary:****

The Customer Service Representative is responsible for supporting the mission statement and production goals by providing customer service support to First Insurance Group clients. Works closely with Benefits Consultants, Benefits Account Executives and Benefit Account Managers to retain and expand customer relationships. Demonstrate and implement our Trusted Advisor strategy to all internal and external customers.

****Duties and Responsibilities:****

* Answer and directs incoming agency calls as needed.

* Maintain knowledge of client-specific plans in order to field employee and client benefit-related questions

* Investigate client claims issue (diagnosis, procedures, proper coding, proper billing).

* Client communication of resolution procedures and timelines.

* Contact health care providers as needed to obtain medical records for claim resolution.

* Assist clients with provider searches, appeals of denied services explanation of benefits and EOBs

* Assist clients with prescription benefit issues/overrides/prior authorizations/alternative medications

* Communicate with carriers regarding claim issues, prior authorization reviews and plan benefits inquiries.

* Log claim issues, service issues, notes and phone calls in Epic.

* Process online and paper eligibility for all applicable clients in a prompt and accurate manner.

* Onsite/Phone FormFire assistance

* Communicate eligibility to carrier via online enrollment systems, via fax, e-mail or phone

* Participate in client employee meetings, answer questions and assist as needed

* Assist in the preparation of presentations, reports and special projects, as needed.

* Maintain current client and carrier contacts listings in conjunction with the Benefits Account Executives and Benefits Account Managers

* Assist Benefits Account Executives and Benefits Account Manager with renewal and mid-year timelines, reporting and presentations

* Maintain client data storage and record keeping in Epic.

* Complete continuing education requirements in order to renew health and life insurance license.

* Participation in various community events and activities.

* Complete special projects and other duties as assigned.

****Education, Certification, License and Experience:****

* Associates degree in related business field; and/or equivalent experience. Health and life insurance license required or willingness to obtain

* Three years of insurance experience preferred

****Skills and Knowledge:****

* Strong knowledge of computer software applications including Excel and PowerPoint

* Strong interpersonal, verbal and written communication skills

* Goal-oriented personality, with high degree of professionalism

* Excellent organizational and customer service skills

* Analytical, problem solving and critical thinking skills

* Ability to be proactive and forward thinking; flexibility and time management skills

* Confidentiality and adherence to HIPAA security guidelines a must.

* Knowledge and understanding of the agencys products, services, policies and procedures

* Overall knowledge of the insurance industry, including a good understanding of insurance industry regulations; knowledge of carriers products and available coverage.

****Work Environment:****

This job operates in a professional office environment. Work is normally performed in a typical interior work environment which does not subject the employee to any hazardous or unpleasant elements.

****Physical Requirements:****

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to speak or hear, stand or sit for long periods of time, open filing cabinets, walk, stoop or bend, use hands to handle or feel and reach with hands and arms. The employee must frequently lift and/or move up to 10 pounds, occasionally lift and/or move up to 25 pounds and complete tasks requiring manual dexterity. Ability to drive a vehicle for travel is required for the position.

***Premier Financial Corp. is an Affirmative Action and Equal Opportunity employer.*** ***We consider all qualified applicants without regard to race, religion, color, sex, national origin, age, sexual orientation, gender identity, disability or*** ***any other legally protected status.***

The above statements are intended to describe the essential functions of the job and the qualifications of the person assigned to it. They are not intended as an exhaustive list of all job duties, responsibilities and requirements. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description does not constitute a contract of employment. Employment is at will and may be terminated at any time.

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