Job Summary

Under the general direction of the Executive Director, serves as a member of the multi-county North Coast Schools’ Medical Insurance Group benefits team. Serves as a key technical and informational contact between Medical, Dental, Vision and Pharmacy carriers, school district personnel, members and providers, including but not limited to, eligibility, billing,and claims. Works under the supervision of the Senior Benefits Specialist and reports directly to, and is evaluated by, the Executive Director. Performs other related duties as requested.

Examples of Duties

• Generates monthly bills and eligibility lists for districts; independently collects and processes data from districts for monthly financial reports;
• compiles and prepares monthly financial reports using electronic spreadsheets; coordinates the implementation of plan changes for JPA members;
• reviews and enters enrollment/change forms using custom web-based computer systems, verifying enrollment information and supporting documentation to determine eligibility;
• updates subscriber information,making necessary changes,and forwards enrollment/change information to vendors adhering to specific timelines;
• utilizes problem solving skills to assist subscribers in resolving Medical, Dental, Pharmacy and Vision claim problems that do not require making exceptions to policy;
• and refers more difficult claim concerns to Executive Director;
• utilizes JPA customized database program involving rates, plans, plan descriptions, subscriber information, change updates, and customer problems;
• answers phones and performs other routine office work as necessary;
• other duties as not specifically described.

Employment Standards

Education and Experience

Graduation from high school and completion of an AA/AS degree in Business, Accounting or other related field. Education may be waived with 3 years of commensurate level of specific insurance experience. Intermediate skill in Microsoft Excel and other related Microsoft desktop applications. Experience in employee benefits, medical office billing, or insurance company or agency operations required.

Knowledge of:

• Excellent oral and written English skills including formal business communications, grammar and medical vocabulary. Proficiency in Spanish is desired, but not required.
• Standard CMS-1500 billing form, as well as ICD-9 and CPT coding systems.
• Code on Dental Procedures and Nomenclature (CDT).
• Construction of insurance contracts and the ability to read and interpret Summary Benefit Description booklets.
• PC computer operations and various standard, custom and web-based program applications.
• Federal HIPAA privacy laws and Affordable Care Act regulations.

Ability to:

• Establish and maintain positive, collaborative and cooperative working relationships with both internal and external customers, including communicating consistently with tact and courtesy.
• Prioritize work to maximize efficiency and productivity.
• Meet changing deadlines and timelines for work completion.
• Ability to effectively convey technical information to non-technical clients.
• Manage complex data systems and spreadsheets with a high degree of accuracy, including written, numeric and calculated data.
• Read, understand and appropriately apply laws, rules and regulations governing all aspects of insurance operations.
• Adjust to changing work conditions and timelines in a fast-pace, emotionally-charged environment, maintaining absolute confidentiality of work-related information.
• Work independently, with low supervision, using appropriate critical thinking and problem solving skills.

Physical Requirements:

• Ability to sit fixed at a computer for long periods of time.
• Dexterity of hands, fingers and wrists to operate a computer keyboard, adding machine, fax machine and other standard office equipment.
• Ability to read, speak, think and hear in an environment of constant noise and interruption.
• Ability to bend or twist the neck, waist, or knees, while performing activities such as kneeling or crouching while filing or shredding and lifting up to 40 lbs.

Range:33 | Personnel Commission Approval: February 10, 2015