Benefits Specialist

• Verify insurance coverage and benefits for potential admissions using Availity, Verify TX, and payer outreach when necessary
• Capture thorough and accurate information for each verification of benefits
• Input insurance data into SalesForce
• Communicate professionally and courteously over the phone
• Collaborate with team members to streamline efforts and avoid duplication
• Run biweekly reports on current census insurance coverage
• Triage urgent verifications of benefits as directed by the admissions management team

Benefits Verification Specialist

• Manage the RFP (proposal) process for new business and existing/growing business
• Evaluate RFP risks for amendments and new groups
• Negotiate pricing, rate competitiveness, and product enhancements
• Analyze RFP documents for underwriting feasibility, experience evaluation, and proposal accuracy
• Administer re-quotes and corrections
• Manage Salesforce data input, stage updates, document uploads, reports, probability, and pipeline
• Build and maintain relationships with Sales Representatives, Brokers, Underwriters, and Employers
• Collaborate with internal and external customers to provide the best possible outcomes
• Demonstrate company values and brand through professional negotiation, responsive communication, daily check-ins, and scheduled meetings

Employee Benefits Proposal Specialist

• Improves participant decision-making by advising participants on plan provisions
• Responds to client-specific inquiries via telephone and web correspondence
• Completes transactions related to customer inquiries with limited supervision
• Meets timeliness and accuracy standards
• Documents calls with detailed notes in the case management system
• Completes callbacks promptly and escalates as appropriate
• Adheres to call center metrics and established procedures
• Explains appropriate participant forms and guides completion
• Performs other duties as assigned
• Complies with all policies and standards

Participant Benefits Services Specialist

• Provide clear and accurate information regarding applicable pension plan provisions
• Respond to participant inquiries through inbound telephone calls and some outbound calls
• Research and address client-specific participant questions while following established procedures
• Complete transactions related to participant inquiries with limited supervision
• Meet established timeliness, accuracy, quality, and productivity standards
• Document participant interactions with detailed and accurate notes in the case management system
• Complete participant callbacks and escalate issues when appropriate
• Follow call center metrics, procedures, and guidelines
• Explain participant forms and provide guidance on completing them
• Adapt to multiple clients’ requirements and procedures
• Maintain confidentiality and security of participant and client information
• Follow company, client, privacy, and security policies and standards
• Perform other duties as assigned

Pension Benefits Services Specialist

• Serve as a primary resource for team member benefits and leave inquiries, providing education and support across health, retirement, voluntary benefits, and leave programs
• Administer benefit enrollments, eligibility, life events, Open Enrollment, FMLA, ADA accommodations, personal leave, and state leave programs
• Manage leave documentation, eligibility, deadlines, accommodations, and return-to-work activities
• Reconcile benefit billing, payroll deductions, enrollment, eligibility, and vendor data, resolving discrepancies with internal teams and vendors
• Use Workday, vendor systems, and Excel to maintain records, analyze data, support reporting, and identify process improvements
• Support ACA, COBRA, ERISA, FMLA, ADA, audits, reporting, communications, and other compliance requirements
• Partner with Payroll, Finance, HRIS, People Partners, Legal, leaders, and vendors to resolve issues and support benefit and leave programs
• Maintain confidentiality, support Elara Caring policies and priorities, and perform other duties as assigned
• Report to the Senior Manager, Leave & Benefits

Benefits & Leave Specialist

• Verify active primary, secondary, and tertiary insurance coverage, including member details, demographics, effective dates, plan type, payer information, and coordination-of-benefits requirements
• Use payer portals, electronic eligibility tools, and direct payer contact to validate coverage and resolve insurance discrepancies
• Contact patients and provider offices to obtain missing or corrected insurance information and escalate unresolved issues
• Investigate benefits for genetic and molecular diagnostic services, including deductibles, copayments, coinsurance, out-of-pocket amounts, benefit limitations, and network requirements
• Identify prior authorization, notification, referral, medical records, and other payer requirements
• Route cases to the appropriate team with complete supporting information
• Document benefit findings, payer representatives, reference numbers, call dates, portal results, and follow-up actions accurately
• Communicate eligibility and benefit findings clearly without making coverage guarantees
• Manage assigned work queues independently, prioritize time-sensitive cases, follow up within established turnaround times, and meet productivity and quality expectations
• Research and resolve routine issues, review work for accuracy and completeness, maintain auditable documentation, and escalate payer, system, or policy issues
• Participate in training, quality reviews, and workflow improvements
• Protect patient, client, financial, and company information in accordance with HIPAA and Baylor Genetics policies
• Perform other job-related duties as assigned

Benefits Specialist jobs in United States

Benefits Verification Specialist

Employee Benefits Proposal Specialist

Participant Benefits Services Specialist

Pension Benefits Services Specialist

Benefits & Leave Specialist

Benefits Investigation and Eligibility Specialist