Research and Resolution Specialist

Recruitment #211021-UNCA-32

Introduction

A resume and cover letter must be submitted with your application.

The Office of Management and Enterprise Services (OMES) is dedicated to providing excellent service, expert guidance, and continuous improvement in support of our partners’ goals. We are a highly-qualified workforce committed to serve those who serve Oklahomans and make government run in the most efficient, innovative manner possible. Achieving this mission takes a collaborative, agile, respectful team with humble leaders who make a difference and get things done. 

For more information about OMES, please visit our website.  

OMES is seeking a full time Research and Resolution Specialist with the Employees Group Insurance Division (EGID). OMES offers a comprehensive Benefits Package, including a generous benefit allowance to offset the cost of insurance premiums for employees and their eligible dependents. For more information about the benefit allowance [click here]. The annual salary for this position is up to $45,300.00 based on education and experience.

This position is responsible for work related to handling complex eligibility and premium accounting referrals of member accounts and providing resolution to members, insurance coordinators, third Party Administrators, and internal staff.

Position Responsibilities
• Handles urgent and non-urgent member and dependent eligibility and premium accounting referrals adhering to all unit procedures and EGID rules and regulations.
• Processes Medicare changes and notifications in compliance with current Center for Medicare & Medicaid Services (CMS) Part D Program (PDP) Guidance, EGID rules and regulations and all unit procedures.
• Processes eligibility updates from Third Party Administrators in compliance with current CMS PDP Guidance, EGID rules and regulations and all unit procedures.
• Processes recurring small reports (Medicare Advantage Prescription Drug Plan Monthly Reports) in compliance with current CMS PDP Guidance, EGID rules and regulations and all unit procedures.
• Processes recurring large reports (CVS Reconciliation Reports) in compliance with current CMS PDP Guidance, EGID rules and regulations and all unit procedures.
• Reviews and analyzes discrepancy reports for various types of insurance or benefits, such as health, dental, life and vision insurance.
• Processes Non-Compliant Forms, Enrollment Forms, Change Forms, Termination Forms, and other assigned correspondence adhering to all unit procedures and EGID rules and regulations.
• Understands and adheres to HIPAA Compliance and Fraud, Waste and Abuse policies and successfully complete annual trainings for compliance.

OMES is an Equal Opportunity Employer. Reasonable accommodation to individuals with disabilities may be provided upon request.

MINIMUM QUALIFICATIONS

• Bachelor’s degree in Business, or a related discipline.
• Minimum two years of experience in bookkeeping work, insurance eligibility determination, maintenance, analysis and reconciliation of insurance or benefits accounts.
• An equivalent combination of education and experience.

NOTES

Please read instructions carefully and include all required documents when you submit your application.

No additional information will be accepted after the application has been submitted.

Conclusion

Veteran’s preference points apply only for initial appointment in the classified service.