Benefit Specialist (Troy, MI)

Location: Troy, MI Summary – The Benefit Specialist serves as the dedicated point of contact for members, providing high-quality support for all healthcare and plan-related needs. This role ensures members receive accurate, timely, and compassionate assistance while maintaining data integrity and streamlining benefit access. Benefit Specialists play a critical role in enhancing member satisfaction, reducing resolution times, and fostering positive relationships. Essential Duties and Responsibilities include but not limited to Member Support Serve as the primary contact for members and providers regarding eligibility, benefits, claims, and coverage questions Respond to inquiries via phone, email, and in-person interactions, including union hall visits and meetings Clearly explain plan benefits, eligibility requirements, deductibles, out-of-pocket accumulators, and coverage details Research and resolve complex issues related to claims, eligibility discrepancies, and coordination of benefits Coordinate with vendors to address prior authorizations, claims issues, and eligibility concerns Initiate outbound calls when necessary to resolve member or provider issues Enrollment and Data Management Process member enrollments, eligibility updates, reinstatements, and terminations based on reported work hours and plan rules Maintain accurate member and dependent records, including demographic and coverage information Administer COBRA events, qualifying life events, and dependent eligibility determinations (marriage, birth, divorce, etc.) Process class code changes, including retirement, disability, Medicare eligibility, and dependent status changes Prepare and distribute enrollment packages, ID cards, and required notifications Review and validate month-end reports, eligibility calculations, and exception reports to ensure accuracy Collaborate with data entry and pension departments to ensure accurate reporting and deductions Claims and Benefit Processing Process and support short-term disability, MRA, SUB and death benefits, ensuring proper documentation and eligibility verification Assist with claims research, eligibility validation, and status updates for members and providers Complete Claim Action Forms (CAFs) and perform manual claim entry as needed Work with internal teams and external vendors to resolve claim discrepancies and escalation issues Ensure timely and accurate processing in accordance with plan provisions and regulatory timelines Data Integrity, Auditing, Reporting Audit vendor eligibility files, discrepancy reports, and billing invoices to ensure accuracy and completeness Review and approve weekly and monthly eligibility file transmissions to vendors Identify and resolve discrepancies in eligibility, vendor reporting, and system calculations Monitor and document system updates, member record changes, and communication history Report system errors or inconsistencies to appropriate departments for resolution Administrative and Operational Support Assist with incoming mail, documentation processing, and special projects as needed Support client and union-sponsored events by providing benefit education and assistance Maintain up-to-date knowledge of plan rules, SPD provisions, and regulatory requirements (COBRA, HIPAA, Coordination of Benefits, etc.) Participate in process improvement initiatives to enhance efficiency, accuracy, and member satisfaction Collaborate with internal teams to ensure smooth workflow and consistent service delivery across multiple clients Qualifications Previous experience in benefits administration, eligibility, claims processing, or healthcare customer service preferred Strong knowledge of healthcare benefits, eligibility rules, and claims processes Excellent communication and problem-solving skills with the ability to handle sensitive or complex situations High attention to detail with strong organizational and analytical abilities Ability to manage multiple priorities in a fast-paced, team-oriented environment Regular and predictable attendance is an essential function of this job Education and/or Experience Post high school education or prior related work experience. Language Skills Ability to read and interpret the plan rules as outlined in the SPD’s, user manuals for online services, department rules and procedures manual and COBRA Compliance manual. Communicate well with Plan Management and higher level. Mathematical Skills Ability to apply concepts of basic addition, subtraction, multiplication and division. Reasoning Ability Representative must be analytical and must be able to deal with people in stressful situations. Superior communication skills and keen observation is essential. Knowledge of healthcare benefits and application and attention to detail. Creative ability to continually improve processes, transmission of information and apply good communication skills both verbally and visually to translate information with ease of understanding to our members, clients and vendors. Physical Demands Extended computer time, deciphering healthcare information and extracting information for both internal/external use. Work Environment Fast-paced, high-volume environment requiring multitasking and attention to detail Combination of independent work and team collaboration Regular use of computer systems and benefits administration platforms Work Schedule Full time. Monday – Friday, 7:30am - 4:30pm. Requires in-office days but also offers at-home flexibility after 90 days. Competitive Benefits and Compensation Package 12 paid holidays Paid Time Off (PTO) Pro-rated during first year of employment 15 days of PTO provided in the next calendar year! Up to 20 days paid jury leave Medical, dental, and vision insurance, with option for dependent coverage Company-paid basic life, short-term disability, long-term disability, and AD&D insurance 401k with employer match Referral bonus for all successful full-time referrals Annual opportunities for increases Pay The hourly rate is $25.00. Actual rate dependent on location, skills, education, experience and other business factors.

ADA & EEO

Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job. #J-18808-Ljbffr BeneSys, Inc.