Member Services & Benefits Specialist

Job Description

Job Description

Position Summary 

The Member Services & Benefits Specialist serves as the primary point of contact for members and dependents of the IAFF Local 935 Health & Welfare Trust. This position is responsible for delivering exceptional customer service, assisting members with benefit questions and claim issues, maintaining eligibility and enrollment records, conducting new hire and open enrollment meetings, and serving as a liaison between members, insurance carriers, providers, and the Trust. 

The ideal candidate possesses strong health insurance knowledge, excellent communication skills, and a passion for helping members navigate their healthcare benefits. 

 

Essential Duties & Responsibilities 

Member Service & Advocacy 

• Serve as the first point of contact for member and dependent benefit inquiries.  
• Answer incoming calls, emails, and service requests regarding medical, dental, vision, life insurance, disability, and other Trust benefits.  
• Educate members on plan benefits, eligibility rules, coverage provisions, and claim procedures.  
• Assist members in resolving benefit and claim issues with insurance carriers, providers, and pharmacies.  
• Act as a member advocate to ensure timely and satisfactory resolution of complex benefit concerns.  
• Maintain detailed records of member interactions and resolutions.  

 

Claims Assistance & Carrier Coordination 

• Research and resolve claim disputes, denials, eligibility issues, and billing concerns.  
• Coordinate directly with insurance carriers, TPAs, provider offices, and members to resolve claim issues.  
• Monitor escalated claims through resolution and provide regular status updates.  
• Assist members with prior authorization, referral, and appeals processes.  
• Review Explanation of Benefits (EOBs) and carrier correspondence to assist members in understanding claim outcomes.  

 

Eligibility & Enrollment Administration 

• Process new enrollments, qualifying life events, terminations, and dependent changes.  
• Maintain eligibility records within the benefit administration system.  
• Ensure all enrollment transactions comply with Trust eligibility requirements and enrollment deadlines.  
• Verify supporting documentation for dependent eligibility and life event changes.  
• Coordinate carrier eligibility files and enrollment audits.  

 

Benefit Administration System Management 

• Maintain accurate member and dependent information within the benefits administration platform.  
• Conduct routine audits to ensure data accuracy and integrity.  
• Coordinate system updates and corrections with internal staff and vendors.  
• Assist with testing and implementation of system enhancements.  

 

New Hire & Open Enrollment Support 

• Conduct new hire benefit orientation meetings.  
• Explain Trust benefits, enrollment procedures, and available resources.  
• Conduct in-person and virtual open enrollment meetings.  
• Prepare enrollment materials and presentations.  
• Assist members with benefit elections during open enrollment periods.  
• Support communication campaigns and educational outreach initiatives.  

 

Compliance & Documentation 

• Maintain confidentiality of protected health information (PHI) in accordance with HIPAA requirements.  
• Ensure enrollment and eligibility processes comply with Trust rules and plan documents.  
• Maintain organized electronic records and documentation.  
• Assist with preparation of eligibility and enrollment reports.  

 

Administrative Support 

• Prepare member service reports and activity tracking.  
• Assist with Trust projects and special initiatives.  
• Support account management and client service teams as needed.  

 

Qualifications 

Required 

• Active California Accident & Health Insurance License.  
• Minimum 3 years of employee benefits, health insurance, TPA, broker, carrier, or claims administration experience.  
• Strong understanding of medical, dental, vision, life, and disability insurance.  
• Experience working with employee benefit enrollment systems.  
• Excellent verbal and written communication skills.  
• Strong customer service and conflict resolution skills.  
• Proficiency in Microsoft Office Suite.  
• Ability to manage multiple priorities in a fast-paced environment.  

 

Preferred 

• 5+ years of employee benefits administration experience. 
• Experience working with labor trusts, Taft-Hartley plans, unions, or public safety organizations.  
• Knowledge of HIPAA, COBRA, Section 125, and employee benefits administration.  
• Experience with Selerix or other benefits administration platforms.  
• Claims adjudication or carrier service experience.  

Company Description

Brown Insurance Services prides itself on a rich history and a seasoned team with over three (3) decades of expertise. Our focus on a human-centered approach, personalized service and the invaluable human touch sets our organization apart in an age increasingly dominated by technology, 800 numbers and automated answering systems. We provide comprehensive services dedicated to ensuring members receive live interaction and one on one attention.

​Our team stands out for its ability to craft tailored benefits programs that align with each client's unique needs and cultural dynamics. Our approach is founded on meticulous planning and a strategic framework honed through years of experience, ensuring that clients derive maximum value from their healthcare investments through cost-effective services.

Company Description

Brown Insurance Services prides itself on a rich history and a seasoned team with over three (3) decades of expertise. Our focus on a human-centered approach, personalized service and the invaluable human touch sets our organization apart in an age increasingly dominated by technology, 800 numbers and automated answering systems. We provide comprehensive services dedicated to ensuring members receive live interaction and one on one attention.\n\n​Our team stands out for its ability to craft tailored benefits programs that align with each client's unique needs and cultural dynamics. Our approach is founded on meticulous planning and a strategic framework honed through years of experience, ensuring that clients derive maximum value from their healthcare investments through cost-effective services.