Customer Service Representative at H&S Energy providing customer service and maintaining store presentation. Responsible for cashiering and ensuring food and beverage quality in a welcoming environment.
About the role
- Customer Experience Consultant in MassMutual's Worksite team, providing support for supplemental health operations. Conduct audits, handle claims inquiries, and optimize processes for improved service quality.
Responsibilities
- Conduct target audits on invoices for supplemental health insurance policies; applied premium, outstanding and suspense payments, and billing discrepancies
- Review and evaluate claims for Accident and Critical Illness products, ensuring compliance with policy terms, regulatory requirements, and state guidelines
- Review and communicate process policy changes, updates, quotes, cancellations, and respond to client inquiries regarding policy details, coverage, and claims
- Handle escalated inbound/outbound calls and emails regarding claims, billing, policy servicing, and portal issues
- Provide exceptional customer service and troubleshoot customer inquiries
- Document use cases, test scenarios, procedures, and decisions needed for operational readiness
- Execute on testing and support User Acceptance Testing (UAT) for claims and billing processes
- Navigate process and customer journey maps, translating insights into operational readiness and improvements
- Develop, review, and maintain Standard Operating Procedures (SOPs) to ensure efficient and up-to-date processes
- Curate and manage a central repository of playbooks, best practices, and resources to support day-to-day tasks
- Work effectively across functional and organizational boundaries, collaborating with Business Analysts (BA), Product Owners (PO), Project Managers (PM), and other stakeholders
- Take ownership of processes from billing to payment, including analysis of flows and requirements, and drive execution
- Support integration of claims with external providers and manage add-on services
- Review current customer service setup (call tree, talking points), analyze flows, and recommend improvements
- Leverage experience with policy administration platforms, and Electronic Data Interchange (EDI)
- Support and assist with Third Party Administrator (TPA) claims training, and review/co-sign TPA claims and billing refunds for accuracy and compliance
- Assist in monitoring CSR performance to ensure service standards are met
Requirements
- 5+ years of Insurance Industry experience and/or supplemental or group health insurance operations, claims backend, billing, and policy servicing
- Experience in customer service, claims adjudication, billing, and policy administration
- Exposure to technical platforms (EIS, EDI) and process improvement initiatives
- Experience supporting TPA operations and training
- Experience in documenting use cases, test cases, procedures, and decisions; ability to analyze and translate process maps into actionable steps
- Ability to navigate and interpret process and customer journey maps
- Proven ability to work in a matrix environment, manage execution, and collaborate across functions (BA, PO, PM, etc.)
- Comfortable taking on E2E responsibility and driving results
- Experience working in Agile environments
- Exposure to quoting, product setup, and enrollment processes in addition to servicing
- Experience with EIS or similar platforms; familiarity with EDI
- Experience working with TPAs and understanding their processes
- Strong communication and interpersonal skills; ability to review and optimize customer service flows
- Experience in monitoring and improving team performance
- Ability to develop SOPs and conduct UAT for claims and billing
- Proficiency in MS Excel and reporting tools
- Understanding of HIPAA, ERISA, and state regulations
- High level of accuracy and attention to detail
- Strong critical thinking and decision-making skills
- Ability to work under pressure, meet deadlines, and adapt to changing priorities
Benefits
- Regular meetings with the Worksite Supplemental Health Operations Team
- Focused one-on-one meetings with your manager
- Networking opportunities including access to Asian, Hispanic/Latinx, African American, women, LGBTQ, veteran and disability-focused Business Resource Groups
- Access to learning content on Degreed and other informational platforms
- Your ethics and integrity will be valued by a company with a strong and stable ethical business with industry leading pay and benefits
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