Customer Service Representative managing accounts and providing product support for Trivium Packaging. Engaging in customer relationship management and handling inquiries efficiently.
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
Job title
Job type
Experience level
Salary
Degree requirement
Location requirements
Customer Service Team Lead empowering a caring customer success team at AlgaeCal. Leading in a hybrid work environment focusing on customer welfare and team performance.
Senior Customer Service Coordinator at Coates managing a team to ensure customer satisfaction and safety. Responsible for administrative tasks and customer solutions at the Albert Park branch.
Customer Service/Warehouse Associate providing support and servicing customers for Dal - Tile, handling transactions and inventory. Maintaining warehouse and ensuring safety protocols.
Customer Care Operations Consultant responsible for optimizing service delivery and workforce performance. Leveraging data - driven consulting and emerging technology solutions in a customer care environment.
Customer Experience Associate at TD helping clients with banking transactions and solutions in Ontario. Aiming to deliver a positive customer experience while achieving business objectives.
Analista de Atendimento integrating the team to provide excellent customer support in credit analysis automation. Managing technical inquiries and ensuring client satisfaction with efficient solutions.
Customer Service Specialist providing support and a seamless experience for dental offices. Blending customer service with knowledge in dental revenue cycle management and logistics.
Family Support Specialist supervising family visits for child welfare in Nebraska. Providing support and coaching for families striving to reunify.
Endoscopy Support Specialist I at Olympus providing service contract support to customers in Philadelphia. Delivering education on equipment cleaning, disinfection, and sterilization while managing key relationships.