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Benefits representative skills for your resume and career

Updated January 8, 2025
3 min read
Benefits representative example skills
Below we've compiled a list of the most critical benefits representative skills. We ranked the top skills for benefits representatives based on the percentage of resumes they appeared on. For example, 18.5% of benefits representative resumes contained customer service as a skill. Continue reading to find out what skills a benefits representative needs to be successful in the workplace.

15 benefits representative skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how benefits representatives use customer service:
  • Resolve customer service related issues via oral and written communications from members and clients while maintaining consistent quality and integrity.
  • Provided excellent customer service to internal employees and external participants, responsible for administration of various group benefits programs.

2. Patients

Here's how benefits representatives use patients:
  • Prioritized Prior Authorization requests; assisted doctors' assistants and patients to obtain exceptions and appeals for non-covered prescriptions.
  • Interviewed Self Pay and under-insured patients to determine eligibility for State and federal financial assistance programs.

3. Insurance Coverage

Here's how benefits representatives use insurance coverage:
  • Qualified to answer employee questions regarding insurance coverage, educational reimbursement programs, pension and retirement plans and miscellaneous benefits.
  • Collect the appropriate information needed to verify insurance coverage for patient medication orders and documents in various different computer systems

4. Medicaid

Here's how benefits representatives use medicaid:
  • Educated and Enrolled potential members about the benefits of a Medicaid managed care organization over traditional fee-for-service Medicaid.
  • Documented and reported inconsistencies to Medicaid and Medicare fraud and/or abuse of prescriptions.

5. Insurance Carriers

Here's how benefits representatives use insurance carriers:
  • Communicated with union officials, insurance carriers, pharmacies and other medical professionals assure member coverage.
  • Resolve complex issue involving enrollment and benefit discrepancies and supply insurance carriers with monthly enrollment report.

6. Term Disability

Here's how benefits representatives use term disability:
  • Prepare short-term disability status report to payroll department on bi-weekly basis, meeting bi-weekly deadline.
  • Worked closely with management to coordinate workers compensation, short and long term disability benefits.

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7. Health Insurance

Here's how benefits representatives use health insurance:
  • Screen applicant eligibility, review and validate documentation necessary for enrollment into NYS sponsored health insurance programs.
  • Assisted employees in resolving health insurance claim problems or questions concerning eligibility or coverage.

8. Hippa

HIPAA, which stands for Health Insurance Portability and Accountability Act, is a United States federal statue created, enacted, and turned to law in 1996, which whose primary purposes were to modernise the healthcare systems in the United States, secure and generally enhance the management of that personal information of patients that was in the hands of healthcare facilities, such as hospitals and insurance companies, and to enable the providing of healthcare and insurance to more people.

Here's how benefits representatives use hippa:
  • Communicated legal guidelines regarding workers compensation, unemployment, disability, COBRA, HIPPA, and Section 125 cafeteria plans.
  • Created policies, procedures and documents for Section 125, COBRA, FMLA and HIPPA compliance.

9. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how benefits representatives use cpt:
  • Monitored denied claims to identify ICD-9 and CPT coding mistakes and omissions that generated the rejection.
  • Utilized and demonstrated knowledge of medical field to include CPT and ICD9 coding and medical terminology.

10. HIPAA

Here's how benefits representatives use hipaa:
  • Trained newly hired and seasonal staff on Health and Welfare Benefits, COBRA compliance, HIPAA, and FMLA regulations.
  • Processed and submitted accurate files pertaining to carrier/vendor feeds, payroll, COBRA, and HIPAA ensuring participant coverage.

11. Financial Assistance

Financial assistance refers to governmental assistance one may receive for a variety of reasons. This help is typically in the form of money, whether a loan, scholarship, grant, or reduced taxes provided to an individual or organization. One of the more common forms of financial assistance is student loans, which offer many prospective students a chance for higher education.

Here's how benefits representatives use financial assistance:
  • Follow up on patient financial assistance status.
  • Conducted benefits trainings for partners * Processed employees' adoption-related financial assistance and allowance requests * Responsible for resolving non-standard eligibility inquires

12. HR

HR stands for human resources and is used to describe the set of people who work for a company or an organization. HR responsibilities revolve around updating employee records and carrying out management processes like planning, recruitment, evaluation, and selection processes. HR is a key contributor to any company or organization's growth as they are in charge of hiring the right employees, processing payrolls, conducting disciplinary actions, etc.

Here's how benefits representatives use hr:
  • Managed leave-of-absence programs and personnel records, administered benefits enrollment and programs, and handled HR generalist workplace issues.
  • Answered HR questions utilizing multiple applications.

13. Medical Benefits

Here's how benefits representatives use medical benefits:
  • Supervised a group of 15 Benefits Representatives in a call center environment administrating Pacific Bell and Southwestern Bell medical benefits.
  • Promoted to interpret and investigate medical benefits for union employees.

14. COB

Here's how benefits representatives use cob:
  • Educated members of new policies/procedures regarding COB rules and regulations.
  • Processed paperless medical claims handled PPO and HMO products Medicare Processing and other insurance COB processing

15. Outbound Calls

An outbound call is made by the call center representative to the customers on behalf of the company. Such calls help increase sales and generate revenue for the organization.

Here's how benefits representatives use outbound calls:
  • Answer inbound and place outbound calls, service existing accounts, obtain orders and determine charges for requested products.
  • Completed outbound calls to plan members to update personal information for files.
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List of benefits representative skills to add to your resume

Benefits representative skills

The most important skills for a benefits representative resume and required skills for a benefits representative to have include:

  • Customer Service
  • Patients
  • Insurance Coverage
  • Medicaid
  • Insurance Carriers
  • Term Disability
  • Health Insurance
  • Hippa
  • CPT
  • HIPAA
  • Financial Assistance
  • HR
  • Medical Benefits
  • COB
  • Outbound Calls
  • Work Ethic
  • Quality Standards
  • Enrollment Process
  • Payroll Deductions
  • HRIS
  • FMLA
  • Medical Claims
  • Benefit Issues
  • Open Enrollment
  • Benefits Administration
  • Inbound Calls
  • FSA
  • HSA
  • Health Benefits
  • Benefit Programs
  • Problem Resolution
  • Status Changes
  • Welfare Benefits
  • ADP
  • Claims Issues
  • ERISA
  • Benefit Changes
  • Customer Inquiries
  • HMO
  • PeopleSoft
  • Insurance Claims
  • ICD-9
  • Life Insurance Benefits
  • Benefits Enrollment
  • Benefit Packages
  • Leave Administration
  • Discrimination Testing

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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