$37.26-$45.30 Hourly / $6,459.00-$7,852.00 Monthly / $77,506.00-$94,224.00 Yearly
According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this class and are not intended to be an inclusive list.
1. Provides written and oral information to members, retirees, medical providers and other interested parties regarding active and retired employee health and welfare benefit programs.
2. Advises and counsels members, retirees, and surviving spouses or domestic partners on available benefits, pursuant to rules and regulations of the Health Service System and federal and state laws.
3. Analyzes and resolves member claim problems.
4. Processes complex claims, and disburses benefits for the Health Service System.
5. Initiates, compiles, calculates, and processes adjustments to member records, premium receivables and medical claim histories.
6. Researches, reconciles, and resolves various member problems related to membership, eligibility, premiums, and medical claims accounts.
7. Interacts frequently and provides training when necessary to subordinate staff engaged in membership enrollments, terminations, accounts receivable, collection, and medical claims adjudication.
8. Consults with plan providers and department representatives regarding the member's status.
9. Conducts workshops for potential retirees and new hires regarding benefits, plans, costs, etc. and assist with the completion of required paperwork. Gives presentations to departmental orientations.
10. Processes and collects manual payments from employees on leave of absence, under COBRA, and retirees.
11. Performs related duties and responsibilities as assigned.
Knowledge of: technical administration of employee benefit programs including health, dental and disability plans, flexible spending accounts, and applicable federal and state laws; medical and legal terminology including the California Procedural Terminology (CPT) coding; and third-party liability and coordination of benefits, including Worker's Compensation.
Ability to: speak clearly to express ideas in a concise, understandable, and effective manner to disseminate benefits information and to conduct effective interviews; communicate effectively in writing by composing and preparing clear and concise correspondence and reports; identify and resolve complex problems in depth by analyzing and interpreting HSS rules and regulations, and numerical data; establish and maintain effective working relationships with those contacted in the course of work; make accurate benefits calculations; and use a computerized data system and various software applications.
1. Possession of a baccalaureate degree from an accredited college or university; AND
2. One (1) year of verifiable experience administering employee benefit programs including: initiating membership records, calculating benefit premiums and processing enrollment applications; processing, researching and/or adjusting benefit claims or problems and updating data; AND
3. Proficiency in the use of computers to perform word processing and to perform data entry/retrieval.
SUBSTITUTION: Additional experience as described above may be substituted for the required education on a year-for-year basis. Thirty (30) semester units/forty-five (45) quarter units equal one year of experience.
Essential duties require the following physical skills and work environment: Ability to work in a standard office environment.