Claims Benefits Specialist for Group Health

POSITION TITLE: Claims & Benefits Specialist for Group Health (Onsite)

CLASSIFICATION: Full-time, Exempt

QUALIFICATIONS: Five years of claims and/or benefits management experience; ability to read and understand benefits plans to administer plan provisions; understanding of Current Procedural Terminology (CPT) and procedure codes; the ability to handle confidential information. Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook. The willingness to initiate new processes, organize and maintain processes, and work cooperatively with other staff.

ACCOUNTABILITY: Reports to the Director of Benefits

Job Summary: The Claims & Benefits Specialist is responsible for reviewing, processing, and resolving group health insurance claims accurately and efficiently, ensuring compliance with policies and regulations, and communicating with various stakeholders to facilitate timely and correct claim resolution. Coordinate with benefits vendors to determine eligibility. Trains local business managers on benefit practices and procedures.

ESSENTIAL DUTIES:

• Coordinate with benefits vendors related to eligibility and claims issues.

• Process Health and Life insurance applications and terminations for all full-time employees.

• Track Life Insurance age band updates and report to Payroll and Finance/Benefits Billing.

• Update health and life deductions in the payroll system for all full-time participants.

• Prepare Health and Life insurance enrollment and termination confirmation notices for participants, including notification to Payroll and Finance/Benefits Billing.

• Prepare Benefits Termination packets for terminating Chancery employees and assist Business Managers with same.

• Track Extension of Benefits enrollment and termination dates, notify Finance, and mail confirmations packets to employees.

• Assist in obtaining health insurance cards from the Claims Administrator.

• Notify the Claims Administrator of any changes in status, name, or address of participants.

• Assist Business Managers and participants regarding Health and Life Insurance benefits issues and plan interpretation.

• Provide training to Business Managers on benefit practices and procedures.

• Have knowledge of medical claims processes to properly resolve medical claims issues for participants with the Claims Administrator.

• Assist Priest with medical claims filing and prepare check requests for approved insurance balances and non-insurance covered services.

• Create and maintain priest, seminarian and religious benefits files.

• Assist in the Benefits Annual Enrollment process.

• Prepare and forward health insurance and pharmacy claims funding request to Finance.

• Forward monthly Claims Administrator's invoice to Finance/Benefits Billing.

• Will also assist during the absence of other department staff, with running reports from the HR Information System, reporting staff information changes, creating new employee records, and pulling files for terminated employees.