Job Details

Job Description

Position Overview

We are seeking an experienced Senior Participant Services Specialist to join our team. This role is responsible for providing exceptional service to participants by handling inquiries, resolving issues, and ensuring accurate processing of claims and benefits. The ideal candidate will have strong communication skills, a background in claims processing, and experience working in a high-volume call center environment.
Key Responsibilities

• Respond to participant inquiries via phone, email, and other communication channels in a professional and timely manner.
• Research and resolve complex issues related to benefits, eligibility, claims, and payments.
• Process claims accurately and efficiently, ensuring compliance with organizational policies and regulatory requirements.
• Utilize internal systems to update participant records, track inquiries, and document resolutions.
• Monitor and analyze account activity to identify discrepancies and troubleshoot potential issues.
• Provide guidance and support to participants regarding plan details, coverage options, and claim status.
• Collaborate with internal departments to resolve escalated issues and ensure participant satisfaction.
• Maintain confidentiality and adhere to compliance standards at all times.
• Assist in training and mentoring junior team members as needed.
• Participate in team meetings and contribute to process improvement initiatives.

Qualifications

• Minimum of 2-3 years of experience in claims processing, benefits administration, or participant services.
• Prior experience in a high-volume call center environment required.
• Strong knowledge of healthcare or union benefit plans preferred.
• Excellent verbal and written communication skills.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook); experience with CRM or call center software a plus.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong problem-solving skills and attention to detail.
• High level of professionalism and customer service orientation.

Why Join Us?

• Competitive salary and benefits package.
• Opportunity to work in a collaborative, mission-driven environment.
• Professional growth and development opportunities.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county , to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.

Job Reference: JN -012###-####18