Participant Services Representative (Bilingual)

Please take a moment to review our benefits package online, which includes, but is not limited to:

• 100% employer-paid medical, dental, and vision coverage
• 100% employer-funded pension and SRP
• 100% employer-paid HRA

The only deductions from your paycheck are taxes!

https://carpenterbenefits.org/isite135/eremit.dll/13501/home

Job Responsibilities

• Develop and maintain proficiency in the Fund’s claims, imaging, and telephone systems to provide efficient, accurate, and professional service to participants, providers, vendors, and other stakeholders.
• Interpret, apply, and clearly communicate Plan of Benefits provisions, policies, procedures, and eligibility requirements to participants, providers, vendors, insurance carriers, and other interested parties.
• Manage a high volume of inbound inquiries while maintaining professionalism, accuracy, and composure in a fast-paced environment.
• Research, analyze, and resolve benefit-related questions and issues by identifying root causes, determining appropriate next steps, and ensuring timely resolution. Collaborate with internal departments as needed, document activities within applicable systems, and escalate complex issues appropriately.
• Update and maintain participant records within the Fund’s systems based on information received through various channels, evaluating the impact of new information on eligibility, benefits, and claims processing.
• Verify the accuracy and completeness of information received and initiate requests for supporting documentation from providers, insurance carriers, participants, or other parties as necessary.
• Review claims history and electronic records to assess the impact of eligibility changes or newly received documentation. Coordinate claim adjustments or corrections with Claims Processing and external vendors while ensuring proper documentation in compliance with HIPAA requirements.
• Explain eligibility, benefits, and claim processes related to weekly illness and injury benefits, life insurance, and disability waiver of premium programs.
• Monitor and respond to email and other communications to remain informed of departmental updates, policy changes, and operational procedures.
• Coordinate eligibility information with external vendors and insurance carriers, including the issuance of identification cards and temporary coverage documentation.
• Process requests for stop payments, payment voids, claim adjustments, and reimbursement recoveries as required.
• Scan, index, and maintain correspondence and supporting documentation within the imaging system in accordance with established procedures.
• Calculate and explain benefits in accordance with applicable benefit plans to assist participants and their representatives with claim-related inquiries.
• Support departmental operations by assisting team members, participating in cross-training activities, and sharing knowledge to promote operational effectiveness.
• Contribute to special projects, process improvement initiatives, and other duties as assigned.

Basic Qualifications

• Ability to handle confidential and sensitive information with a high level of discretion and professionalism.
• Demonstrated ability to work effectively and collaboratively in a team-oriented environment.
• Strong multitasking skills with the ability to prioritize work, maintain accuracy, and meet deadlines under moderate supervision.
• Working knowledge of medical terminology.
• Ability to make sound decisions in accordance with established policies, procedures, and guidelines.
• Excellent organizational skills with strong attention to detail.
• Strong problem-solving and critical-thinking abilities.
• Excellent written and verbal communication skills.
• Demonstrated reliability through consistent attendance and punctuality.

Preferred Qualification

• Bilingual in Spanish, with the ability to communicate fluently when bilingual support is needed.

Work Authorization

MACB only hires individuals who are legally authorized to work in the United States. This position does not offer sponsorship for work visas. Candidates holding temporary visas (including E, F-1, H-1, H-2, L, B, J, or TN) or those who require sponsorship now or in the future are not eligible for this role. Please, no calls or agency inquiries.

Equal Opportunity Employer

MACB is an Equal Opportunity Employer. We consider all qualified applicants for employment without regard to sex, race, color, religion, national origin, age, marital status, political affiliation, sexual orientation, gender identity, genetic information, disability, or protected veteran status. We are dedicated to maintaining a workplace free from discrimination and harassment

Pay: $22.00 - $24.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Experience:

• customer service: 3 years (Required)

Language:

• spanish (Required)

Ability to Commute:

• Chicago, IL 60611 (Required)

Work Location: In person

Salary : $22 - $24