State of Maryland

An Employee Benefits Specialist Lead/Advanced is the lead or advanced level of professional HR work in the Department of Budget and Management (DBM) and is assigned specialized enrollment, claims issue resolution and counseling work related to the application and interpretation of laws, rules, regulations and policies governing the State’s Employee and Retiree Health and Welfare Benefits Program, which is under the jurisdiction of the Department of Budget and Management, Office of Personnel Services and Benefits. Employees in this classification have the knowledge and experience to perform the most complex benefits-related tasks and assignments.  Employees in this classification function as technical experts in the State Personnel Management System (SPMS) in the area of health benefits and have the ability to handle the full range of duties relating to enrollment and customer service within the Employee Benefits Division. Employees in this classification may assign, review and approve the work of lower-level Employee Benefits Specialists and provide training to lower-level employees and Agency Benefit Coordinators.

Employees in this classification receive general supervision from a designated administrator. The work requires employees to answer frequent telephone calls and to exercise tact and diplomacy in responding to inquiries and respond calmly to heated discussions in regard to health benefits issues. The work may require travel throughout the State of Maryland. Employees are required to obtain and maintain certification in SPMS policies and procedures and in the functionality of the Statewide Personnel System (SPS) in order to demonstrate knowledge, understanding and skill in the administration of the State’s Employee and Retiree Health and Welfare Benefits Program.

Positions in this classification are evaluated by using the classification job evaluation methodology. The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

The Employee Benefits Specialist Lead/Advanced is differentiated from the Employee Benefits Specialist IV in that the Employee Benefits Specialist Lead/Advanced serves as an advanced analyst and is designated as a key technical and primary subject matter expert in benefits. Employees in this classification may assign, review and approve the work of lower-level Employee Benefits Specialists. As a key technical and primary subject matter expert in employee benefits matters, employees in this classification also may perform the most complex benefits-related tasks and special assignments while the Employee Benefits Specialist IV performs the full range of day-to-day assignments and responsibilities under general supervision.

Performs the most complex reviews of cases with multiple benefits issues to be resolved;

May assign, review and approve the work of lower-level Employee Benefits Specialists;

May train lower-level Employee Benefits Specialists and Agency Benefits Coordinators;

Advises program participants of available health benefits options in order to provide assistance with making informed health care decisions;

Interprets and applies health benefits laws, rules, regulations and policies;

Develops benefits-related training materials for use Statewide;

Prepares for and makes presentations and training sessions Statewide for groups of employees, employee representatives, and Agency Benefits Coordinators to explain health benefits procedures, restrictions and requirements;

Communicates with Health Benefits Vendors to resolve participant claim coverage issues;

Researches participant records using computer databases, other agency and control agency information systems and identifies discrepancies in the payment of deductions resulting from events such as agency transfer or military active duty;

Counsels participants and retirees in one-on-one settings and on the telephone and performs the required follow-up to provide requested information;

Prepares correspondence to participants, Agency Benefits Coordinators and Health Benefits vendors in response to information requests and determinations;

Conducts pre-retirement seminars for participants at various locations throughout the State;

Completes necessary documents to ensure expeditious and effective initiation of payments from retirees;

Informs separated participants about options to temporarily continue health insurance coverage by application for Consolidated Omnibus Budget Reconciliation Act (COBRA);

Reads and interprets Account Detail section of Benefits Administration System in order to accurately assist members with account information;

Reads and navigates the online payment system (Velocity or similar system) to assist end users in password resets and making/scheduling payments;

Performs a variety of report-related tasks, including working vendor error reports, age reports, evidence of insurability report, EGWP/PDP reports, etc.;

Handles 60-day exception requests;

Processes administrative corrections in accordance with applicable benefits laws/regulations/procedures;

Performs tasks related to 61st day closure of benefits events in the SPS;

Works with Shared Services on system troubleshooting, system updates, integrations issues, and other complex matters relating to the administration of benefits utilizing the SPS and BAS;

Participates in and is integrally involved in Open Enrollment and ACA-related activities;

Completes special assignments independently that require in-depth knowledge of benefits;

Performs other related duties.

Knowledge of office procedures, business English, spelling, grammar and arithmetic;

In-depth knowledge of benefits and ability to apply Health Benefits Program plans, rules, regulations, and policies to complex situations;

Ability to apply retirement-related State laws/regulations/policies as these relate to health benefits administration;

Skill in analyzing large data sets and working with comprehensive reports;

Ability to interpret and apply State Central Payroll regulations;

Ability to provide exceptional customer service;

Ability to navigate proficiently in a variety of system applications, such as: MOJO or similar help desk ticketing systems, Benefits Administration System, Workday and Velocity or similar online payment system;

Ability to identify and correct errors regarding information provided by participants, State agencies, Health Benefits Vendors and others;

Ability to accurately analyze and address the issues presented by participants and other interested parties; 

Ability to communicate effectively;

Ability to make presentations before small and large groups and to present information in a clear and concise manner;

Ability to establish and maintain effective working relationships with co-workers, division staff, other government officials and the general public;

Ability to effectively lead lower-level Employee Benefits Specialists and provide clear instruction and guidance on full range of tasks;

Ability to use various computer software applications such as Word and Excel;

Ability to work on a wide variety of complex projects with a high degree of independence;

Ability to exercise tact and discretion in dealing with State employees, co-workers, the general public, and government officials.  

Experience: Six years of experience responding to inquiries, calculating program eligibility, counseling and advising persons concerning health benefits.

Notes:

1. Candidates may substitute the possession of a Bachelor’s degree from an accredited college and university and four years of experience responding to inquiries, calculating program eligibility, counseling and advising persons concerning health benefits for the required experience.

2. Candidates may substitute the possession of a Master’s degree from an accredited college or university in Business Management, Business Administration, Human Resources or Public Administration for four years of the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Human Resources classifications or Human Resources specialty codes if the work includes benefits-related experience on a year-for-year basis for the required experience.

1. Employees in this classification are required to obtain certification in State Personnel Management System policies and procedures and in the functionality of the Statewide Personnel System from the Office of Personnel Services and Benefits, DBM within six months from the time of the appointment to the position. Employees also are required to obtain recertification every six months thereafter.

2. Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may be required to possess a motor vehicle operator’s license valid in the State of Maryland.

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System.  All positions in this classification are Skilled Service positions.  Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is not assigned to a bargaining unit, as indicated by the designation of S (Supervisor), M (Manager), T (Agency Head), U (Board or Commission Member), W (Student), X (Used by Agency or Excluded by Executive Order), or Z (Confidential).  As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded from collective bargaining.  Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.