Client Services Representative II (50981)

Job Description Summary

The Client Service Representative II (CTSR) reports to the Supervisor of Client Services and is responsible for the enrollment, implementation and education of Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc. (Pinnacle) health benefit plan participants, as well as interfacing with third party vendors as they relate to employee health benefits. This includes the investigation of problems/issues to determine source of the problem, evaluation of investigation results and determination of necessary corrective action for problem/issue resolution using established procedures and protocol. Provides mentoring and training assistance to new hires and Level I Client Service Representatives and compiles and tracks data pertaining to problems/issues, action taken and resolutions.

Duties And Responsibilities

Team Development

• Travel to field offices to observe/assess Client Service Representative's enrollment and service techniques and identify trends and training needs as assigned by Client Service Supervisor.
• Develop and deliver client service training for newly hired and current Client Service Representatives.
• Assist Supervisor of Client Service in developing departmental policy/procedures and job aids for all Client Service Representatives.
• Assist in developing standard operating procedures (SOPs) for the client service process.
• Support career progression by helping team members set and achieve development goals.

Education Services

• Educate newly enrolled and existing plan participants on health plan and ancillary benefits at the client group's work site locations, via phone or virtual platforms.
• Conduct group benefits presentations in both English and Spanish for WGAT and PCMI plan participants.
• Interface with third party vendors/providers to communicate and educate them on benefits and programs specific to WGAT plan participants.
• Act as a point of escalation for complex enrollment issues.

Member Services

• Assist with the enrollment of participants, and screen all enrollment paperwork for accuracy and completion.
• Liaise with Client Service Supervisor to organize assigned group service meetings and open enrollment for the most economical and effective use of time.
• Investigate and respond to WGAT and PCMI participant claims and administration questions utilizing the WGAT Health Care Processing System and the CTSR web-based tool(s).
• Determine necessary corrective action for problem/issue resolution using established documentation procedures and protocol.
• Request Benefits Information Booklet and Summaries of Benefits and Coverages for health benefit information specific to each WGAT account.
• Support Regional Sales Manager/Account Manager/Broker/Client with plan comparisons, pre-filled enrollment/waiver forms, and any other materials or requests as needed.
• Attend employee client events to assist with benefits inquiries, provide materials to plan participants, and promote and enroll plan participants in value-added programs.

Data Collection

• Compile and track data pertaining to problems/issues, action taken and resolutions using the Client Service Representative web-based tool.
• Document all services to include; enrollments, service meetings, employee client events, wellness events, courtesy calls and visits utilizing the CTSR web-based tool.
• Track and analyze metrics, identifying trends and opportunities for improvement.
• Provide feedback to leadership on challenges and recommendations for enhancing the process.
• Assist in the development of strategies to optimize outreach and increase participation rates.

Other

• Utilize all capabilities to satisfy one mission - to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
• Maintain a clean DMV record and the ability to travel to locations throughout the US (mainly California and Arizona) up to 40% of the time.
• Other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to travel to both indoor and outdoor areas that can vary in exposure and temperature. The employee is frequently required to operate a motor vehicle, use objects, tools, or controls, and/or required to lift up to 50lbs. The noise level in the work environment is usually moderate.

Qualifications

• High School diploma and a minimum of three (3) to five (5) years prior customer service experience and employee benefit plans and/or medical/dental claims handling or equivalent combination of education and experience, preferred.
• Fluency in Spanish is required, with both written and verbal proficiency , and the ability to use Spanish for up to 70 % of the time.
• Strong knowledge of computer software programs used to access and/or update customer records.
• Excellent written and oral communication skills to include modern business communications (e.g. Microsoft Suite, emailing, Zoom), formatting of professional letters, reports, and phone etiquette.
• Excellent customer service skills.
• Advanced skills in establishing priorities, multi-tasking, time management, and ability to work independently with minimal supervision in a team environment. Advanced knowledge of health insurance operations and industry.
• Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. up to 40% of the time.