Are you a genuine, detail-oriented analytical thinker with a passion for being a team player while analyzing claims data, supporting documents, and answering participant phone calls?   

What we’re looking for in our  Customer Service Representative /Claims Adjudicator...  

This is ONE role, which is the perfect fit for someone who loves to review claims, investigate details, and apply appropriate rules while helping customers and keeping accurate records.

*Important: This position is more than just adjudicating claims. We’re looking for someone to cultivate positive relationships with our participants and our community, and be an innovative and strategic thinker.

What you’ll be responsible for as a Customer Service Representative/Claims Adjudicator: 

• Review and assess insurance/benefit claims for completeness and accuracy.

• Verify coverage, eligibility, and supporting documentation.

• Approve or deny claims based on policy terms and established criteria.

• Request additional information from claimants or providers when necessary.

• Communicate decisions clearly and professionally to internal teams and external parties.

• Maintain accurate and thorough records of claim determinations and actions taken.

• Collaborate with other employees, claimants, and providers.

• Stay current with changes in industry regulations, company policies, and adjudication procedures.

• Meet performance targets for claim turnaround time, accuracy, and customer satisfaction.

You'll also thrive in this role if this sounds like you:

1. You have a strong attention to detail. People tend to compliment you on your strong attention to detail, and you're constantly reviewing your work multiple times to ensure it's as thorough as possible.

2. You’re a confident decision-maker. You love taking initiative over your tasks to get them started and completed, which means you don't need to be micromanaged. You can apply the guidelines and rules to the claims that need to be analyzed promptly.

3. You are over the moon passionate about the company's mission! You always go the extra mile to ensure customers' needs are taken care of!

In a nutshell, you have:

• Experience in FSA, HRA, Dental, and Vision Claims Areas

• High school diploma or equivalent required; associate or bachelor’s degree in a related field preferred.

• Familiar with Microsoft products and general computer knowledge

• Familiarity with claims management systems and relevant software

• Strong analytical and problem-solving skills.

• Excellent organizational and communication abilities.

• Ability to handle sensitive information with confidentiality and professionalism.

Being a part of the team means:

• You love being a part of a hard-working team and collaborating online or on the phone with customers and other team members 

• You’re all about fast pace – you thrive in a fast-paced environment, which always has a variety of tasks to attend to

You in? Here are the details:

Position: Full-Time (approx. 40 hrs per week)  

Hourly Rate: $18 USD/hour  

Benefits: 

• Health, dental, and vision insurance are available

• 401(k) with company match

• Paid time off and holidays

Position Start Date:    Immediate           

Location: Albany, NY

Email Resume to: HR@tpgplans.com