Employer Service Representative

United StatesRemotemid

OtherMember Services Representative

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Quick Summary

Key Responsibilities

Serve as a primary contact for assigned employer groups regarding benefits administration and service inquiries Respond to employer, broker, and member requests via phone, email,

Requirements Summary

High school diploma or equivalent required; associate or bachelor's degree preferred 2+ years of customer service or account management experience in healthcare, insurance, benefits administration,

Technical Tools

OtherMember Services Representative

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

The Employer Services Representative (ESR) serves as the primary point of contact for employer groups and brokers within a mid-size third-party administrator (TPA) environment. This role supports day-to-day client service operations related to benefits administration, eligibility, billing, enrollment, claims coordination, and employer account maintenance while helping to develop best practices. The ESR is responsible for delivering accurate, timely, and professional support while maintaining strong relationships with employer groups, internal departments, carriers, and vendors.

Responsibilities

~1 min read

→Serve as a primary contact for assigned employer groups regarding benefits administration and service inquiries
→Respond to employer, broker, and member requests via phone, email, and ticketing systems within established service standards
→Educate employer groups on TPA processes, policies, eligibility rules, and available services
→Build and maintain positive working relationships with clients and brokers
→Coordinate with claims, provider relations, and stop-loss departments to resolve escalated issues
→Research claim status inquiries and facilitate timely resolutions
→Track and document service issues to ensure follow-through and client satisfaction
→Maintain confidentiality and ensure compliance with HIPAA and company policies
→Document client interactions and account activity accurately within internal systems
→Support audit requests and reporting needs as required
→Participate in employer implementations and renewals
→Identify opportunities for process improvement and enhanced client experience
→Support special projects and cross-functional initiatives as assigned

Requirements

~2 min read

High school diploma or equivalent required; associate or bachelor's degree preferred
2+ years of customer service or account management experience in healthcare, insurance, benefits administration, or TPA operations
Experience in a self-funded health plan or TPA environment preferred
Knowledge of ERISA, COBRA, HIPAA, and ACA requirements preferred
Experience working with brokers, employer groups, and carrier partners
Working knowledge of group health benefits, eligibility, claims processing, and billing practices
Proficiency in Microsoft Office Suite and ability to learn multiple administrative systems
Strong attention to detail and organizational skills
Clear and confident communication skills for both internal and external customers

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

Pay Transparency

$50,000—$55,000 USD

Benefits:

Comprehensive medical, dental, vision, and life insurance coverage
401(k) retirement plan with employer match
Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
Paid time off (PTO) and disability leave
Employee Assistance Program (EAP)

Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.