Healthcare Benefit Specialist (Bridgeton, MO)

Benefit Specialist (Bridgeton, MO)

The Benefit Specialist determines, maintains, and terminates member and/or dependent eligibility for health care benefits. Responds to incoming telephone calls from members and providers regarding medical, dental, vision, disability and reimbursement account claims and benefits. Reviews claim data to ensure accuracy of processing in accordance with Plan provisions.

Essential duties and responsibilities include but not limited to:

• Know the plan rules for eligibility and healthcare benefits as outlined in the Summary Plan Description (SPD) for each fund.
• Assist callers with questions regarding deductibles, out of pocket accumulators, medical, prescription and disability benefits. Professionally and accurately respond to incoming calls from members and providers to include:
• Explaining group benefits
• Assisting with claims eligibility issues
• Confirming claims status
• Assisting the callers with their questions or concerns and providing problem resolution
• Use month-end reports to determine eligibility, reinstatement and termination of health care coverage.
• Prepare and mail enrollment packages and ID cards to all newly eligible members.
• Carefully review month-end calculation report, exception report, post H&W report and pension check H&W deduction reports.
• Work with Data Entry department to ensure that reported work hours are properly recorded and computed.
• Assist members and their dependents with all issues regarding eligibility for benefits.
• Work with pension department to ensure H&W deduction amounts are correct and deducted properly for retired members and widows.
• Audit monthly H&W Pension deduction reports.
• Request and evaluate legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules.
• Review monthly status reports and self-payment notices before mailed to members to ensure information is correct.
• Mail manual self-payment notices to members who receive late hours or make late payments.
• Determine qualifying events and notify member/dependent of COBRA rights.
• Responsible for Class Code and coverage changes when member's status changes, such as adding dependents, disability, retirement, death and when dependents reach maximum age for coverage.
• Send proper enrollment documents to members adding children or a spouse.
• Request missing address for members from employers.
• Change Class Code for members eligible for Medicare and enter Medicare effective dates and MBI number in BeneSys systems.
• Process enrollment verifications.
• Process death notifications.
• Verify and maintain employee enrollment information, e. g., member and dependent address, phone number, date of birth and social security numbers.
• Process incoming Eligibility appeals and prepares for Board of Trustee (BOT) Meeting presentation.
• Respond to requests from Plan Managers and Trustees, as requested.
• Communicate with various vendors regarding prior authorizations and eligibility issues.
• Review and approve weekly and monthly eligibility extracts to be sent to vendors.
• Mail participant requests and resolve participant issues.
• Audit vendor reports and invoices monthly as well as work vendor weekly file discrepancy reports.
• Identify and report to Programming Department, any system errors in work-hour computations.
• Audit vendor reports and invoices monthly.
• Identify and report discrepancies in vendor invoices and month-end reports to Manager.
• Comment in system when changes are made to participant record or when participant/vendor/provider calls with request.
• Review and approve new Plan changes (rule changes/rate changes) when applicable, after Programming has completed entering the changes.
• Update Redbook when necessary, within 48 hours of change notification.
• Ensure Client Site has most accurate and up-to-date information for Fund that he/she has been assigned.
• Make outgoing calls to members and providers when warranted.
• Send Claim Action Form (CAF) for claim resolution and completing all CAFs assigned to their attention.
• Responsible for manual entry of claims as directed by Supervisor or Manager.
• Other duties as may be assigned.
• Regular and predictable attendance is an essential function of this job.

Qualifications - Must be able to service multiple clients, to include the interpretation of Plan language and schedule of benefits. Must have knowledge of and be able to effectively communicate regulatory requirements and legal terminology to include COBRA, HIPAA, Subrogation and Coordination of Benefits. Must be flexible and willing to work as a team member. Education and/or Experience Post High School education or prior related work experience. Language Skills Ability to read and interpret the plan rules as outlined in the SPD, user manuals for on-line services, department rules and procedures manuals and COBRA Compliance manual. Must be able to communicate well with Plan Management and higher level employees. Mathematical Skills - Ability to apply concepts of basic addition, subtraction, multiplication and division. Reasoning Ability - Specialist must use creativity to continually improve processes and transmission of information, including by applying excellent verbal and visual communication skills to convey information to members, clients and vendors. Physical Demands Extended periods of sitting and keyboarding and deciphering healthcare information to extract information. May involve some light lifting. Ability to use office equipment such as a copier and fax machine. Work Environment - Typical office environment that, at times, can be busy and noisy. This is an in-office position, and the ability to maintain regular and predictable attendance in the office is an essential function of this position. Work Schedule - Full time. Monday and Friday - 7:30am - 4:00pm Tuesday, Wednesday, Thursday - 7:30am - 4:30pm. Required in office (no at-home days).

Competitive Benefits and Compensation Package

• 15 days Paid Time Off (PTO) during first full calendar year
• 12 paid holidays
• Medical, dental, and vision insurance, with option for dependent coverage
• Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
• 401k with employer match
• Flexible spending accounts
• Tuition reimbursement program
• Career development opportunities
• Referral bonus for successful candidates
• Annual opportunities for increases

Pay - Hourly rate ranges from $21.00 - $23.00. Actual rate dependent on location, skills, education, experience and other business factors.

Our Culture

BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees' successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential. Our culture focuses on three core values:

• Collaboration: working together across 31 locations to achieve the best for the company and our clients
• Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
• Integrity: doing what we say we will do. Upholding strong ethical and moral principles

ADA & EEO Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.