STATE GROUP INSURANCE PROGRAM BENEFITS SPECIALIST

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Requisition No: 821436

Agency: Management Services

Working Title: STATE GROUP INSURANCE PROGRAM BENEFITS SPECIALIST - 72002680

Pay Plan: Career Service

Position Number: 72002680

Salary: $38,500.00 - $40,000.00

Posting Closing Date: 02/08/2024

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Benefits Specialist

Division of State Group Insurance

State of Florida Department of Management Services

This position is located in Tallahassee, FL

Position Overview and Responsibilities:

The Department is seeking a motivated professional to serve as a Benefits Specialist in the Member Services Section within the Bureau of Contracts and Member Services. This role will provide direct member and customer service support regarding eligibility and enrollment in the State Group Insurance Program. This position will provide support and leadership in a variety of division projects and activities and serves as primary point of telephone contact for the division. The level of direct member and customer service support provided requires the selected candidate to possess a thorough knowledge and understanding of the laws, rules, policies, and procedures governing state benefit programs, as well as the People First system and operational procedures.

Specific responsibilities will include, but are not limited to, the following:

Member and Customer Support:

• Level II Enrollment and Eligibility Appeals: performs research sufficient to address all issues raised in appeals; prepares proposed agency action letters for approval by director; and mails follow-up letter if additional time to respond is needed. Maintain databases/logs of enrollment and eligibility appeals, assigns appeals, sends member appeal acknowledgement letter.
• Research policy questions/issues and assist with drafting policy clarification documents.
• Serve as the issue resolution liaison between members and vendors such as People First, health plans, pharmacy benefits manager, and supplemental insurance plans.
• Respond to routine requests, provides technical assistance and educational information to members regarding benefits and enrollment and eligibility processing within the People First system using available resources.
• Identify member complaint trends and recommend educational or communication strategies to mitigate future complaints and issues.
• Serve as policy and process liaison to other divisions to provide guidance, resolve issues, and improve processes.
• Assist with developing training materials and help facilitate training related to enrollment and eligibility.
• Draft letters for management's signature and mailing.
• Coordinate and manage all activities related to the Weight Management Pilot Program (WMP) including all WMP reports. Assist with WMP annual open enrollment activities:
• Monitor content and resource accuracy of our websites.
• Provide cross functional support to other DSGI work units for special projects and during peak workload periods as required to support the Division's operational needs and benefits administration processes.
• Assist with processing Medicare Enrollment Verifications.
• Act as backup support for Open Enrollment activities, this may include traveling to Open Enrollment benefit fairs when necessary.
• Provide expert witness testimony for administrative hearings related to enrollment and eligibility appeals.

Operations:

• Research, gather, and provide information on participant eligibility, effective dates and other data for audits, claim assessments, and routine requests by appropriate insurance vendors, etc.
• Establish, maintain, and revise standard operating procedures as needed.
• Assist with enrollment and eligibility audits (spouse program, ineligible dependents, etc.).

Leadership and Strategic Thinking:

• Provide input on the effect of State Group Insurance policy on participants in the Program, and any related impacts to the People First system. Assesses impact of policy and/or rule changes on participants.
• Review new or revised rules, legislation, strategic plans and proposals on benefit issues for impact on the personnel information system and presents findings and/or makes recommendations.

Knowledge, Skills, and Abilities:

• Knowledge of Florida Statutes, and policies and procedures governing the State Group Insurance Program, including Chapter 60P, Florida Administrative Code.
• Knowledge of federal laws, rules and regulations governing or affecting pretax benefit programs, including but not limited to section 125 of the IRS code, COBRA, Medicare, ACA and HIPAA, etc.
• Knowledge of Florida Insurance Code and/or employee group benefits.
• Knowledge of People First procedures and system.
• Proficient in Microsoft Office suite.
• Strong oral and verbal communication skills.
• Ability to work with a variety of stakeholders in sometimes difficult situations while maintaining professionalism and world-class customer service.
• Ability to effectively and efficiently work both independently and as a contributing member of a team. Ability to plan, organize and prioritize own work assignments to meet deadlines.
• Knowledge of developing training materials and conducting training seminars.
• Experience in customer service.
• This position requires sedentary work with repetitive motion.
• Accountability, Communication, Empowerment, Flexibility, Integrity, Respect, Teamwork.

Minimum Qualifications:

• A high school diploma, or its equivalent, and a minimum of three years of professional work experience in a human resources position performing duties related to employer group insurance benefits.
• Experience with Microsoft Office, Word, Excel, Outlook, and Adobe.

Preferred Qualifications: A bachelor's degree from a college or university in the area of human resource management, insurance, risk management, administration, customer service, statistics, personnel, or any combination thereof.

Our Organization and Mission:

The Department of Management Services (DMS) is a customer-oriented agency responsible for managing the various business and workforce-related functions of state government. Under the direction of Governor Ron DeSantis and the DMS Executive Leadership Team, the agency oversees the real estate, procurement, human resources, group insurance, retirement, technology, telecommunications, fleet, and federal property assistance programs utilized throughout Florida's state government. It is against this backdrop that DMS strives to demonstrate its mission, “We serve those who serve Florida.” Under the leadership of DMS Secretary Pedro Allende, DMS employees embody four pillars on a daily basis: lead by example, serve with excellence, create efficiencies, and challenge the status quo.

Special Notes: DMS is committed to successfully recruiting and onboarding talented and skilled individuals into its workforce. We recognize the extensive training, experience, and transferrable skills that veterans and individuals with disabilities bring to the workforce. Veterans and individuals with disabilities are encouraged to contact our recruiter for guidance and answers to questions through the following provided email addresses: View email address on us.fitly.work View email address on us.fitly.work An individual with a disability is qualified if he or she satisfies the skills, experience, and other job related requirements for a position and can perform the essential functions of the position with or without reasonable accommodation. Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must contact the DMS Human Resources (HR) Office at View phone number on us.fitly.work. DMS requests applicants notify HR in advance to allow sufficient time to provide the accommodation. Successful completion of background screening will be required for this position.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center View phone number on us.fitly.work). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS' PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans' Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.