Employee Benefits Customer Service Representative

. Handle claims resolution, benefits inquiries, coverage eligibility concerns, and related issues for client administrators and employees .

Posted 9/25/2026full-timeRemote • New Jersey • United StatesMid-LevelSenior💰 $22 - $25 per hourWebsite

Key responsibilities & impact

Handle claims resolution, benefits inquiries, coverage eligibility concerns, and related issues for client administrators and employees
Work with clients and carriers by phone and email to resolve matters within 24 hours
Address employee insurance concerns and benefit-related questions
Assist with claims resolution, patient advocacy, and pre-certifications
Educate employees on benefit utilization and cost-effective plan options
Maintain detailed client interaction records in Salesforce
Generate client analysis reports as needed
Use Salesforce to gather client information and improve service quality
Monitor resolution timelines and ensure benefit issues and claims are closed within designated timeframes
Review Summary Plan Descriptions and benefit summaries for accuracy
Advise clients on insurance billing, coding, employee group benefits, insurance processes, and plan descriptions
Serve as a primary team resource for insurance and benefit-related issues
Address member eligibility inquiries, enrollment entry, and coverage confirmation

What you’ll need

Three plus years’ experience working in a customer service/call center environment
Experience with an insurance industry carrier, broker, or insurance-related vendor
Knowledge of eligibility claims, medical coding, and billing
Knowledge of benefit summaries and Benefit Plan Descriptions
Exceptional verbal and written communication abilities
Outstanding organizational and multitasking capabilities
Strong problem-solving skills
Skilled at taking initiative, prioritizing tasks, and meeting tight deadlines
Proficiency in Spanish, written and spoken, is a plus
Collaborative team member
Adaptable and detail-oriented
Proficient in Microsoft Office Suite