Client Services Representative

Overview

This position is responsible for, but not limited to providing coordination and oversight for the Flex Department, customers, and clients that EBS serves.  The Flex Coordinator ensures that our clients are pleased with the services performed by EBS and our business partners. The Flex Supervisor oversees vendor and client relationships and ensures that the organization is cultivating a customer-centric environment that anticipates and proactively responds to our client’s needs.  The Flex Coordinator is responsible for building relationships with internal and external customers/stakeholders as well as within their own department. The Flex Coordinator will act as the central communication point for client issues within the Flex Department.  Additionally, the Flex Coordinator will assist in the implementation of new client’s analyzing plan designs and formulating a strategy to meet the customer’s needs.

Responsibilities
Display a thorough understanding of all aspects associated with a client’s benefit plan(s) to include, but not limited to:

• Flexible Spending Accounts, Dependent Child Care Accounts, Health Savings Accounts, Health Reimbursement Accounts
• Plan Language
• ERISA, HHS, and ACA regulatory requirements
• The life of a participant’s claim with the ability to identify the proper steps necessary to rectify issues that may arise
• Understanding of ICD-10 and medical claim filing formats.
• Understanding of CPT and HCPCS codes
• Understanding of Coordination of Benefits
• Knowledge of deductibles, co-pays and co-insurance
• Basic knowledge of electronic files
• Understanding of HIPAA rules – must protect the security of medical records to ensure that confidentiality is maintained
• Maintain relationships with internal and external customers by providing high-quality customer service.
• Communicate with insured, agent, provider and/or stop loss carrier to obtain details necessary for proper claims adjudication.  Display the ability to communicate information and ideas so others will understand.
• Transmit payments or further investigate until the file is resolved.
• Maintain a 95% processing accuracy.
• Comply claims turnaround timelines.
• Report overpayments, underpayments, and other irregularities.
• Actively participate in external and internal industry education sessions.
• Ensure that all regulatory and Company policies are followed and maintained.
• Required Education:  High school diploma or GED required.  Associates degree from an accredited college preferred.

Required Work Experience:  Previous experience in TPA industry, healthcare industry and specifically billing /coding position is preferred.

Technology Skills: General office equipment including computer and peripherals, copier, scanner, fax, calculator.  Telephone, cellular phone, headset usage.

Required Skills or traits for the position:

• Job requires being honest and ethical.

• Job requires being careful about detail and thorough in completing work tasks.
• Job requires persistence in the face of obstacles.
• Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
• Job requires maintaining composure, keeping emotions in check.
• Job requires being reliable, responsible and dependable/ fulfilling obligations.
• Job requires a willingness to take on responsibilities and challenges.
• Job requires accepting criticism and dealing calmly/effectively with high stress situations.
• Job requires self-sufficiency, Capable of independence.  Apply processes and tools.  Recommends improvements.
• Specialized Training/Certifications: Licensing/certification is not required for the position.

Equal Employment Opportunity

At World Insurance Associates (WIA), we celebrate and support our differences. We know employing a team rich in diverse thoughts, experiences, and opinions allows our employees, our products, and our community to flourish. WIA is honored to be an equal opportunity workplace. We are dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, WIA makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of our business.