Benefits Coordinator

• Investigate and determine the correct benefits for members with multiple health insurance plans
• Review insurance eligibility, policy coverage, and documentation to verify the proper payer order
• Contact insurance carriers, Medicare (CMS), employer groups, healthcare providers, and members by phone, email, fax, and mail to validate coverage information
• Research complex healthcare eligibility issues and apply Medicare CMS and NAIC guidelines to determine primary and secondary coverage
• Document findings accurately in company systems while maintaining complete and detailed records
• Review Explanation of Benefits (EOBs) and other insurance documentation to support payment determinations
• Process incoming COB correspondence and update eligibility records as needed
• Handle inbound and outbound calls related to Coordination of Benefits inquiries
• Meet established productivity, quality, and turnaround time goals
• Maintain HIPAA compliance and adhere to federal, state, and client requirements
• Collaborate with teammates while working independently in a remote environment
• Identify opportunities to improve processes, documentation, and communication

• Coordinate new-hire benefit enrollment, qualifying life-event changes, and benefit terminations
• Respond to employee questions about eligibility, coverage, enrollment, deductions, claims navigation, and benefit resources
• Escalate complex benefits matters appropriately
• Maintain accurate employee benefit records across HRIS, benefits administration, payroll, and carrier systems
• Review enrollment and eligibility data, investigate discrepancies, and coordinate corrections
• Support annual open enrollment, including system configuration, employee communications, educational materials, tracking, and audits
• Assist with carrier invoice and eligibility-file reconciliation and resolve variances
• Assist with administration of medical, dental, vision, life, disability, flexible spending, health savings, retirement, wellness, and other benefit programs
• Provide administrative support for leave-related benefit continuation, premium collection, and return-to-work updates
• Assist with required notices, reporting, audits, and record retention related to benefit laws and plan requirements
• Prepare routine benefits reports and monitor service trends
• Coordinate with brokers, consultants, third-party administrators, and benefit carriers
• Protect confidential employee and health information and follow privacy, security, and records-management requirements
• Support benefits communications, employee education sessions, and other HR initiatives
• Complete required trainings and perform other duties as assigned
• No supervisory responsibilities

• Collect, analyze, and prepare information for client requests and client-team activities
• Ensure outgoing client deliverables are accurate and peer reviewed
• Manage assigned client-team tasks, including Forms 5500, policy review, monthly carrier reporting, and updating BenefitPoint, AMS, and other software
• Handle assigned project-management portions for clients
• Attend client meetings and conference calls with team members
• Provide guidance and gather data for clients’ day-to-day questions
• Attend consultant and vendor meetings and internal and external trainings
• Independently manage assigned project components and work products
• Meet internal deadlines
• Research and produce financial analytics through data collection, analysis, and interpretation
• Develop rate and financial spreadsheets
• Develop and assist with client RFP execution, including RFP-result analysis and insurance-carrier follow-up
• Review SPDs and contracts for technical accuracy
• Research health and welfare compliance questions with client-team and internal-resource support

Senior Employee Benefits Coordinator

• Facilitate and manage service fulfillment within the assigned region
• Engage and support health plan members, long-term care insurance policy holders, and direct-to-consumer customers
• Assist with benefit/service understanding, resource optimization, service coordination, and communication with providers
• Cultivate professional relationships with The Helper Bees’ aging-in-place service provider network
• Promote best practices in platform utilization, customer engagement, referral management, scheduling, service completion, and invoicing
• Monitor referral activity to ensure timely assignment, acceptance, and service fulfillment
• Resolve referral escalations and customer service tickets by reviewing platform/dashboard activity and engaging providers or customers
• Prioritize timely referral fulfillment to meet program requirements and ensure customer satisfaction
• Self-manage scheduled follow-up engagements
• Perform high-volume inbound and outbound telephonic coordination
• Collaborate with Account Managers on reporting, escalations, grievances, eligibility, and referral issues
• Collaborate with management to assess performance and redirect efforts as needed
• Meet or exceed monthly encounter fulfillment goals and performance metrics

Regional Benefits Coordinator

• Monitor UKG benefits interfaces daily to identify and resolve data discrepancies or failed transmissions
• Monitor the Benefits Mailbox and respond to or route employee inquiries
• Review and process monthly vendor billing statements for accuracy against enrollment data
• Reconcile billing discrepancies with vendors and coordinate timely resolution and payment
• Maintain organized billing records to support audits and month-end close
• Upload and reconcile employee eligibility files to Headspace
• Upload and reconcile employee eligibility files to Scripta
• Support Open Enrollment coordination and communication
• Support year-end data validation
• Provide compliance support
• Complete other ad hoc benefits projects as needed

Benefits Coordinator jobs in United States