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Contract Benefit Specialist Application

Home/Contract Benefit Specialist Application

Contract Benefit Specialist Applicationadmin2018-03-20T18:41:41+00:00

Contractor Information

First Name *
Last Name *
Date of Birth: MM/DD *
Last Four Digits of Social Security Number *
Preferred Phone *
Primary Email *
Street Address *
Apt, Suite, Bldg. (optional)
City *
State / Province / Region *
Postal / Zip Code *
Country *

Experience

Years of Enrollment Experience *
What are your speciality areas?
One-on-one EnrollmentCase ManagerCall CenterTeam Leader
If case management is a specialty area, list the enrollment group(s) below. If not, enter "NA." *
If team leadership is a specialty area, list the enrollment group(s) below. If not, enter "NA." *
Do you hold a High School Diploma or higher? *
YesNoGED
Types of license:
LifeP&CAccident & Health
List special benefit or CE education courses. If none, please enter "NA." *
Do you currently hold an Errors & Omissions Insurance Policy? *
YesNo
If yes, list the Carrier, Policy Number, and Expiration Date.
If no, are you willing to provide your own policy?
YesNo
Do you have a valid Driver's License? *
YesNo
Are you proficient with enrollment software? *
YesNo
If yes, list enrollment platforms in which you have experience:
What is the largest group size you have enrolled in the past five (5) years? *
Are you bilingual? *
YesNo
If yes, which language(s) do you speak fluently?
Do you have auto insurance? *
YesNo
List your auto insurance carrier:
Do you have core benefit experience? *
YesNo
Do you have voluntary benefits experience? *
YesNo
Select all products enrolled within the past five (5) years:
HSAVisionTerm LifeShort-term DisabilityHigh deductible plansWellnessEmployee AssistanceMedicalPet InsuranceHearingUniversal LifeLong-term DisabilityLong-term CareCancer InsuranceLegalDentalWhole LifeBasic Life/AD&DFlex Spending AccountCritical IllnessAccident InsuranceTeledoc
Select all that apply within your last five (5) years of experience.
Call CenterUtilized Voice AuthorizationMock PresentationLaptop PresentationBenefit Fairs4th Quarter EnrollmentsOne-on-one PresentationGroup EnrollmentsGroup PresentationDaily Quality Measurements
Are you comfortable explaining benefits to a large group? *
YesNo
Non-residence license(s) held as of the date of this application:
ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVTVAWAWVWI
Are you willing to obtain any non-residence state licenses? *
YesNo
Will you need to use a Clear Track HR laptop for this enrollment? *
YesNo
Do you have a laptop or desktop computer with high-speed internet access? *
YesNo
If yes, which operating system do you use?
WindowsMACLinuxOther

Emergency Contacts

Primary Contact

Full Name of Primary Contact *
Relationship *
Phone *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Secondary Contact

Full Name of Secondary Contact *
Relationship *
Phone *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Travel Information

If you have travel restrictions or limitations, please explain. If no, please enter "NA." *
Do you have a major credit card? *
YesNo
Do you have a bank account for use with direct deposit? *
YesNo
Airport Nearest Your Home *
Enter your preferred airline.
If applicable, enter your Frequent Flyer Miles Number.
If applicable, enter your AAA Member Number. *
Enter your preferred rental car company.
If applicable, enter your rental car membership number:
Are you a tobacco user?
YesNo

References

Full name of referrer:
Phone
Referrer title/occupation
Full name of referrer:
Phone
Referrer title/occupation
Full name of referrer:
Phone
Referrer title/occupation

Additional Comments

In the space below, provide any additional information you believe to be important as we consider your application.

Certification

My responses are true and complete. *
I hereby certify that all listed answers and responses are true and complete to the best of my knowledge.
If contracted, I understand that false information could lead to my dismissal. *
If this application leads to employment, I understand that false or misleading information in this application or in my interview may result in my termination from the company.

Verification

Please enter any two digits *Example: 12
This box is for spam protection - <strong>please leave it blank</strong>:

How can we help you?

19 Biltmore Dr NW
Huntsville, AL 35806
866.581.0496

info@cleartrackhr.com

Consultant Opportunities

ClearTrack HR is always accepting applications for qualified, motivated Employee Benefit Specialists interested in working on a contract basis.

Click the link below to submit your application.

Solutions

Benefit Administration

Billing Reconciliation

Data Reconciliation

Dependent Eligibility Verification

Electronic Data File Feed Services

Medicare and Medicaid Consulting

Consumer-Directed Healthcare

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