ERC Call Center Quality Assurance Analyst bei Higginbotham Insurance Agency

The ERC Benefits and Claims Specialist is a key role in the Day 2 Services-ERC Department at Higginbotham. Is responsible for ensuring a thorough knowledge of claims, research tools, and resources to serve employees and employers effectively.

This role is centered around evaluating and reviewing claims with precision and accuracy. The individual must be meticulous to determine the claims’ validity and ensure that insurance carriers’ payments are made per policy terms and regulatory requirements. The ERC Benefits and Claims Specialist will also support as backup to the ERC Benefits Specialists, take employee calls, and respond to emails and texts as needed during non-peak and peak times.

Please note that this job description may be subject to changes and revisions.

Key Responsibilities:

• Maintaining documentation, spreadsheets, products, and services as requirements change.
• Serving as a subject matter expert on reviewing and assessing insurance claims, analyzing documentation, calculating benefit payments, liaising with claimants and insurance agents, utilizing specialized software, interpreting policy coverage, negotiating settlements, and providing expert testimony.
• Drive continuous process improvements and create the claim/customer service process, training documentation, and manual.
• Assisting Account Managers/Producers in the setup and maintenance of required Claim Services.
• Assist in creating/Writing Standard Operating Procedures (SOP)
• Provide exceptional customer service
• Answer and advise clients (employees, retirees, and dependents) regarding their benefit plans as appropriate. 
• Research questions and issues as necessary, including discussion with appropriate Carriers and Producer Teams
• Assist with client (employees, retirees, COBRA participants, dependents) enrollment into the appropriate enrollment tool (paper or electronic).
• Log all activity into designated software for reporting purposes. (Document all calls and emails and comments in EPIC)
• Ensure that all client requests (calls, voicemails, emails, etc.) are answered within 3 business hours.  (i.e. voicemail is left at 5:00pm on Friday, call must be returned by 11:00am on Monday.)
• Return employee, client, and Account Manager phone calls and emails promptly
• Enroll employees according to their current enrollment systems
• Answer benefits, HR, and claims-related calls as needed by clients
• Assist with COBRA Administration as needed.
• Build and maintain processes and templates (with Management assistance) to complete tasks more efficiently and effectively.
• As time allows, assist and cross-train on other team functions.
• Assist with marketing Higginbotham’s products and services to clients and prospects as requested.
• Meet deadlines
• Adhere to Higginbotham’s Employee Handbook
• Adhere to Goals and Objectives as presented by the Company and Leadership of your Team for your R&R
• Understanding client expectations
• Knowledge and understanding of the healthcare insurance industry
• Ability to maintain confidentiality and adhere to HIPAA requirements
• Ability to resolve any issues or concerns

Specific Knowledge, Skills and Abilities:

• Proficient understanding of claims, carriers, provider relations - contract, and provider interactions.
• Computer proficient
• Knowledge of employee benefits, COBRA administration, and insurance
• Maintain an appropriate license and certifications for advising employees on insurance products.
• Thorough knowledge of employee benefit plans and their operations. 
• Good working knowledge of COBRA administration a plus. 
• Ability to create, copy, edit, save & send using Word, Excel & Outlook
• Ability to type and talk at the same time and navigate through multiple screens
• Must be comfortable working in various software programs at the same time.
•  Must be organized and detail-oriented, self-motivated but not afraid to ask questions. 
• Needs to be comfortable working with all types of people and on multiple projects simultaneously.
• Good working knowledge of COBRA administration is a plus.
• Excellent communication, writing, and grammar skills.
• Ability to create, copy, edit, save & send using Word, Excel & Outlook.
• Ability to type and talk at the same time and navigate through multiple screens.
• Must be comfortable working with various software programs at the same time.
• Must be organized and detail-oriented, self-motivated, but not afraid to ask questions.
• Comfortable working with all types of people and on multiple projects simultaneously.

 Physical Requirements:

• Ability to lift 25 pounds.
• Repeated use of sight to read documents and computer screens
• Repeated use of hearing and speech to communicate on the telephone and in person
• Repetitive hand movements, such as keyboarding, writing, 10-key
• Walking, bending, sitting, reaching, and stretching in all directions

Core Competencies:

• Leadership: Display leadership skills and ability to motivate fellow employees (If applicable)
• Ability to Analyze and Solve Problems: Skill in recognizing challenges, exploring options, and implementing effective solutions in a timely manner
• Attention to Detail: A strong focus on completing tasks and projects accurately and thoroughly
• Communication Skills: Capable of expressing ideas clearly in both verbal and written forms and engaging with various audiences
• Timely Task Completion: Ability to finish tasks and projects efficiently, managing resources and priorities effectively
• Team Collaboration: Willingness to work together with others, promoting teamwork and supporting shared goals
• Client Focus: Dedication to understanding and addressing the needs of clients and stakeholders to ensure their satisfaction
• Dependability: Acknowledgment of the importance of being present and punctual.
• Creative Thinking: Openness to suggesting new ideas and methods to improve processes and outcome
• Organizational Skills: Capability to prioritize tasks and manage multiple projects simultaneously
• Adaptability: Willingness to adjust to changing situations and priorities, showing resilience in a dynamic work environment

Experience and Education:

• Five or more years of employee benefits, insurance experience, claims-carrier knowledge, and customer service in business/industry experience are required.
• Must have a current / Active General Lines Insurance License.
• Bilingual / Spanish is helpful but not required. 

Systems:

• Proficient with Microsoft Excel, Word, PowerPoint, and Outlook
• Applied Epic experience preferred, but knowledge of similar Account Management System (AMS) is acceptable

Physical Requirements:

• Ability to lift 25 pounds
• Repeated use of sight to read documents and computer screens
• Repeated use of hearing and speech to communicate on telephone and in person
• Repetitive hand movements, such as keyboarding, writing, 10-key
• Walking, bending, sitting, reaching and stretching in all directions

Notice to Recruiters and Staffing Agencies: To protect the interests of all parties, Higginbotham Insurance Agency, Inc., and our partners, will not accept unsolicited potential placements from any source other than directly from the candidate or a vendor partner under MSA with Higginbotham.  Please do not contact or send unsolicited potential placements to our team members.