E.D.I.S. is a Third Party Administrator (TPA) who is in the business of showing employers how to reduce the cost of their group medical plans without reducing benefits. We work alongside our broker partners to find the best package and solution.
We are proud to a management team with a combined total of more than 350 years in the industry, a sales team with a combined total of more than 45 years of experience, and a staff of 70+ that stands behind the service we provide.
We are committed to walking out of the office each day knowing that we've put forth the best effort to produce the highest quality result possible for each of our clients.
We want to be the TPA whose actions make it clear that we are here to serve you, our partner and our clients. We would be honored if you would trust us with your business.
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Join Our Team
Employer Driven Insurance Services is all about hiring quality people. We truly believe quality people doing quality work is what allows us to provide a quality result for our clients. We are focused on finding team members who will be with us for the long run, who are going to grow in their talents and advance into positions that truly utilize their strengths. We believe that being part of a successful work family is just one element of a truly happy and balanced life. Because of that belief, we offer medical, dental, vision, matching 401K and paid vacation, holidays and sick time to our full-time employees. To find out if E.D.I.S is the right place for you, submit your resume to email@example.com. We look forward to hearing from you regarding the open positions below:
Job Summary: Manages incoming calls from members, providers, brokers, and agents. Researches issues to find resolution for the caller and manages response time to achieve 24 hour turnaround. Accesses claim system to respond to caller and to adequately track calls received. Works with other members of the Customer Service team to achieve team goals in the areas of speed of answer and calls per day. Assists with customer inquiries as needed for other areas of the office and acts as a resource in the resolution of difficult issues. Duties and Responsibilities: • Receive, investigate and respond to all customer inquiries when taking incoming calls • Manage incoming calls and resolve issues within 24 hour turnaround. • Manages follow up system so all unresolved calls receive a call back and resolution within required timeframes. • Monitor e-mails and respond to all questions and inquiries within established timeframes. • Adhere to work schedules (lunch and breaks) to achieve maximum service capacity • Assist with refund recovery process and complete research as needed. • Track all calls taken using acceptable call tracking vocabulary and processes. • Handles all open calls within established timeframes. • Complete outgoing customer calls to explain benefits and claim status. • Completes outreach calls to assigned groups to insure service levels are maintained. • Work with Claim department to identify error trends and ensure claim adjustments are communicated properly. Qualifications: • Must have a high school diploma or GED • Two years customer service experience • Insurance industry experience required • Bilingual in Spanish a plus
Job Summary: Manages group and individual enrollment process and interacts effectively with agents, group contacts and underwriting dept. to ensure the group is correctly set up in the processing system(s). Completes eligibility, distributes ID cards and enrollment packages to new group. Updates existing group eligibility including new hires, terminations and changes to group information. Cancels terminated groups and finalizes all processes necessary to complete group cancellations. Creates plan documents and distributes to group as necessary. Essential Functions: • Processes new groups and loads into the El Dorado and/or Wex processing systems • Builds the mask for all new and existing groups with benefit changes • Ensures ID cards are accurate and carrier information is correct • Verifies all information is provided to process new or renewing group and contacts employer if additional information is needed. • Meets established quality and productivity goals for processing eligibility. • Performs quality checks of new groups as needed. • Serves as resource to customer service regarding administration issues. • Works with IT department to ensure system processes work correctly. Competency Requirements: • Excellent organizational skills • Time management skills with focus on prioritizing tasks • Ability to work both independently and in a team setting • Problem solving and decision making experience. • Detail orientation with experience in data input. • Excellent communication skills both written and verbal • Proven interpersonal skills and ability to interact with other areas to satisfy customer needs • Computer knowledge with skill to navigate Web and locate carrier information Required Skill / Experience: • Insurance knowledge with a preferred minimum of 2 years working in insurance industry • Knowledge of group health benefits and carrier plans
THIS POSITION AVAILABLE IN EAST TEXAS OFFICE Job Summary: Receives and processes new business across all product lines. Provides effective communication verbally and in writing to the writing agent, the group and the appropriate sales team member. Additionally, handles all aspects of the renewal process for designated business. Essential Functions: • Breaks down and ensures accuracy and completeness of new and renewing business. • Keeps the agent, group and sales member in the loop through professional communication both verbal and in writing. • Interacts with carriers, general agents, plan loading, accounting and administration to ensure all information for new case start up is delivered. • Notifies inside sales representatives and manager of any serious service issues which may impact group’s implementation or retention. • Ensures the benefits are correct as received. • Researches carrier benefits and makes recommendations for integration of our product with new benefit plans for renewing groups. • Completes documentation in CSI and any other necessary documentation in the required timeframe. • Delivers financial reports to sales team, clients and supports brokers with renewal activity. • Attends weekly/monthly sales meetings when needed and interacts with other members of the Sales/ Field Service Team to establish best practices and improve service levels. Competency Requirements: • Excellent organizational skills • Time management skills with focus on prioritizing tasks • Leadership skills and experience working independently • Problem solving and decision making ability. • Proven interpersonal skills, experienced in customer relations. • Ability to influence outside partners and identify positive alternatives to claim system limitations. • Computer knowledge with skill to navigate Web. Work Experience & Education Requirements: • The position requires three or more years experience in the insurance industry with focus on benefit plans and agent/client communication.
Job Summary: Processes claims for third party administrator after reviewing carrier EOB and determining benefit allocation by reviewing plan design and schedule of benefits. Reviews carrier and provider information to determine correct adjudication of third party benefit. Uses previous claim processing experience to interpret and understand unusual plan designs and coding procedures to process claims while maintaining high quality levels. Essential Functions: • Reviews carrier EOB and processes claims in accordance with employer benefit plan • Meets or exceeds established goals in relation to productivity and quality metrics. • Completes written communication with outside parties as needed to explain benefit payments and denials. • Researches carrier documents to ensure claim payments are accurate. • Utilizes benefit schedules and resources effectively to support claim payment process. • Works with Customer Service, Benefit Plan Loading and other areas to improve processes and workflows. • Works with IT department to ensure system processes work correctly. • Follows and adheres to all office policies, procedures and practices to enhance claim productivity and quality. • Demonstrates ability to assist team members with complex claims, adjustments and special projects. Competency Requirements: • Excellent organizational skills • Time management skills with focus on prioritizing tasks • Ability to work independently. • Problem solving and decision making experience. • Detail orientation with experience in analyzing data. • Proven interpersonal skills to interact with other areas. • Computer knowledge with skill to navigate Web and locate carrier documents Required Skill / Experience: • Claim processing experience, two years preferred • Knowledge of carrier benefit plans and processes • Excellent communication skills - written and verbal.
Why E.D.I.S is Set Apart From the Rest
· In its first year, E.D.I.S. wrote more than 100 stop loss clients becoming the top TPA in the nation for its stop loss carrier.
· E.D.I.S. ensures that every stop loss, MEC plan it offers includes complete aggregate protection to reduce and limit an employer’s plan liability.
· E.D.I.S. was the first TPA in California to implement solutions to overcome the strict self-funding regulations of SB-161 which requires alternative set up and additional tracking.
· Our EDHP™ program returned more than 2 million in unused claims funds to its clients in 2017 and is on target to surpass that in 2018. Where other stop loss carriers and TPA’s keep a portion of the unused claims fund, E.D.I.S. returns 100% to the employer.
· E.D.I.S. is also committed to returning 100% of any pharmacy rebates received through its EDHP™ program to the client whose member has earned it. This is another area where other TPA’s keep the money, or only pass a small percentage through to its client.
· For no additional charge, E.D.I.S. provides a mobile friendly Online Web Portal, Concierge Service, creation and maintenance of required ERISA documents to include a Summary Plan Description, Plan Document, Summary of Benefits & Coverage, Notice of Material Modification and ACA required notices.