Employer Service 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.

Primary 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, 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

Qualifications:

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.