INSURANCE BENEFITS ANALYST 3 - 01282025-64968

Job Information

LOCATION OF (3) POSITION(S) TO BE FILLED: DEPARTMENT OF FINANCE & ADMINISTRATION, BENEFITS ADMINISTRATION DIVISION, DAVIDSON COUNTY

This position is work from home

Qualifications

Overview

Responsibilities

Provide Consultation and Advice to Others:

1. Provides guidance and advice to members and agencies on billing inquiries, policies of the Plan, Insurance Committee decisions and Federal and State laws. Analyzes reports and queries to determine noncompliance, keying and payroll errors.
2. Serves as an internal consultant to solve complex issues and provide technical assistance in Benefits Administration functional areas to subordinates, peers, and supervisors to ensure consistency and equity in policy and practice.

1. Independently investigates complex issues assigned by management team and determine appropriate solution.
2. Ensures compliance with federal and state laws and Plan documents.
3. Investigates administrative error exception requests to determine if correction needs to be made or escalate to management.
4. Conducts quality assurance reviews of calls by randomly selecting recorded calls, or listening to live calls handled by analysts and evaluating responses; document findings, take corrective action as necessary and forward results to management.

1. Researches billing transactions (e.g., retroactive transactions, individual billing, retirement payroll, agency billing) to determine whether adjustments, refunds or additional collections are needed, and communicate discrepancies to payroll when appropriate.
2. Analyzes information and research to determine if money is owed, an overpayment has been made, or if any other billing-related action needs to be taken.
3. Analyzes completed insurance enrollment, dependent verification, and special qualifying events for eligibility and accuracy.
4. Analyzes queries to identify inconsistencies in keying; update system to correct.
5. Analyzes operational or management reports for corrective action.

1. Provides coaching to subordinates on appropriate performance management techniques for all systems in accordance with recommendations as directed by management or from F & A Human Resources Office.
2. Conducts Quality Assurance audits to ensure quality standards are being met within the policies and procedures of Benefits Administration guidelines.

1. Communicates accurate and detailed information to members, agency benefits coordinators, other state agencies and vendors in person, by phone, email, or written correspondence regarding complex eligibility, enrollment, billing and other insurance options.
2. Confirms plan member eligibility for outside vendors and other entities such as pharmacists and doctors offices.

1. Interprets and communicates state and federal laws and regulations and the plan document affecting the administration of benefits to members and agency benefit coordinators.
2. Asks detailed questions of caller to properly investigate the issue presented. Utilize a variety of resources to verify or research the information and provide the caller with the appropriate response.
3. Interprets and explains information/data to team regarding performance metrics or reviews.

1. Utilizes mainframe and internet applications to research and process enrollments, changes; researches Federal and State Laws.
2. Monitors call volume and hold times and assign staff to ensure phone coverage is meeting the pre-established goals and providing the most effective customer experience.
3. Creates spreadsheets to analyze data.

1. Plans and coordinates the activities of assigned subordinates to ensure that operational and strategic priorities of management are met, and conflicts in scheduling and responsibilities do not arise.

1. Updates work processes as required by system, procedural or policy changes.
2. Reviews management communications regarding Federal and State laws and Plan Document updates and changes.
3. Participates in annual required HIPPA and Fraud training.

1. Manages multiple projects and work activities simultaneously while adhering to performance expectations.
2. Obtains clarification from manager when determining priority of work.

1. Notifies supervisor of an escalated situation or irate member, peer or team member.
2. Provides feedback to management regarding subordinate training needs.
3. Recognizes the performance of subordinates in accordance with established policy and communicate to supervisor.

1. Maintains effective relationships with agency benefits coordinators by providing timely and accurate response to their inquiries and concerns.
2. Conducts regular team member meetings to ensure consistent application of procedures and policies.

Competencies (KSA's)

1. Dealing with Ambiguity
2. Problem Solving
3. Functional/Technical Competencies
4. Technical Learning
5. Directing Others
6. Perseverance
7. Organizational Agility
8. Approachability
9. Ethics and Values
10. Integrity and Trust

1. Customer Service
2. Health Benefits Administration
3. Microsoft Office, Enterprise Resource Planning (ERP), databases
4. English Grammar, Spelling and Pronunciation
5. Financial Analysis
6. Methods and Techniques of Research, Analysis & Report Presentation

1. Writing, Speaking and Reading Comprehension
2. Critical Thinking
3. Evaluating and Solving Complex Problems
4. Service Oriented
5. Self Directed
6. Adapting to Changing Situations
7. Motivating, Developing, and Leading Team Members
8. Active Listening and Learning
9. Time Management
10. Mathematics
11. Learning and Instructing Techniques and Strategies
12. Negotiation and Influencing Others
13. Monitoring Processes and Performance

1. Written and Oral Comprehension
2. Written and Oral Expression
3. Multitasking
4. Problem Recognition
5. Deductive and Inductive Reasoning
6. Prioritize Tasks and Meet Deadlines
7. Speech Clarity and Recognition
8. Retention of Policy and Procedural Information
9. Comprehension of Abstract Concepts and Application to Work Situations

Tools & Equipment

1. Personal Computer
2. Telephone
3. Fax Machine
4. Printer
5. Scanner/Copier