The benefits service & administration for active employees provides the client a wide variety of services. This service includes direct contact with participant’s situations and HR issues.
• Benefit Administration: Managing and processing of active employees benefits such as: enrollments, cancellations, coverage changes, investigations on medical coverage issues, appeal process, pharmacy issues, medical and prescriptions pre authorization procedures, documents requests, reimbursement process, duplicate ID requests, students certifications, life insurance claims, open enrollment process.
• Call Center Administration: Provides orientation to all active employees on the following: health insurance benefits such as: enrollments, cancellations, coverage changes, Cobra benefit and requirements, investigations on medical coverage issues, appeal process, pharmacy issues, medical and prescriptions pre authorization process, processing of documents requests, reimbursement process, duplicate ID requests, students certifications, medical coverage issues & life insurance benefits.
• COB: Confirmation of notification of employees and retirees with two health insurances in order to establish primary health insurance for the processing of services received.
• Invoices Reconciliation: Validation and processing of companies’ health and life insurance billings including submitting adjustments and reports.
• Self-service Platform: Online platform available to all active employees with access to all benefits and health insurance information provided by the employer. Availability to make demographic changes, life insurance beneficiaries changes as well as benefits changes during the open enrollment period. Online platform available for Human Resources to keep track of all employees benefits and changes as well as availability of personalized reports as per the company’s needs.
• Reports: Availability of reports requested by Client such as: headcount reports, health insurance active employees, cancellation reports, enrollments reports, received and processed transactions, SLA reports, life insurance benefits report as well as phone calls received and any other customized report requested.