Health Benefits Specialist 3 (MAS3/AHSO)

Health Benefits Specialist 3

This is a remote position that is typically not required to report on-site.

This recruitment may be used to fill multiple positions.

This position works in a customer service and call center environment to explain medical benefit scope of care, enroll Washington Apple Health (Medicaid) clients into managed care plans, resolve procedural problems involving clients, insurance carriers, or providers, and research to resolve complex inquiries regarding claims, problems, and conflicts in the Medical Assistance Customer Service Center (MACSC). If you enjoy providing excellent customer service via phone, learn quickly, and demonstrate strong problem-solving skills, this may be the position for you.

This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. HCA has currently suspended the ability to support out-of-state telework.

Some of what you will do:

• Provides expert consultation to clients, providers, Managed Care Organizations (MCO), local community service offices (CSO), and stakeholders regarding benefits and services provided by the Apple Health (Medicaid) program, and other state programs in a call center environment and in writing.

• Counsels and advises customers on Health Care Authority (HCA) policies, scope of care, clients’ rights and responsibility, and Medical Assistance policy, procedure, and health benefits.
• Tactfully manages difficult situations and provides quality customer service.
• Coordinates service referral, eligibility information, and managed care membership information between managed care plan, local CSOs, other state agencies, community service organizations, and medical and social services providers.
• Assists customers in resolving disputes and other issues related to their benefit service package or managed care plan.
• Resolves complex questions, claims issues, complaints, and problems about eligibility, accessibility to services, enrollment, and other insurance coverage.
• Assists customers in determining managed care eligibility, selecting and enrolling in or changing managed care plans, and resolving issues regarding health care choices and access to medical services.
• Analyzes, evaluates, and assists with claims submission for medical and social service providers.
• Maintains a thorough knowledge of ProviderOne (P1), Point-Of-Sale pharmacy claims processing system (POS), Automated Client Eligibility System (ACES), Treasury Management System (TMS), Siebel Contact Management System and Siebel and Avaya soft phone, State and Federal Title XIX policy, managed care programs, HealthPlanfinder application (Health Benefit Exchange System), and medical terminology.

Required qualifications:

• Medical Assistance Program Knowledge : Demonstrated ability to interpret and apply applicable federal and state laws, regulations, policies, procedures, and program requirements related to medical assistance programs, benefits, eligibility, enrollment, services, or claims.
• Independent Analysis and Determination : Demonstrated ability to independently research, analyze, and evaluate complex information to make accurate determinations and resolve program-related issues within established authority.
• Customer and Stakeholder Consultation : Demonstrated ability to provide accurate technical information, consultation, and assistance to customers, providers, members, partners, and other stakeholders regarding medical assistance programs and requirements.
• Professional Communication : Demonstrated ability to communicate complex or technical information clearly, accurately, and professionally, both verbally and in writing, to individuals with varying levels of program knowledge.
• Quality, Accuracy, and Compliance : Demonstrated ability to independently produce accurate, complete, and timely work while ensuring compliance with applicable laws, regulations, policies, procedures, and established program standards.
• Workload and Priority Management : Demonstrated ability to independently organize and prioritize complex assignments, manage competing demands, meet established timelines, and judgment with limited supervisory direction.

Required competencies:

• Equity Lens – All HCA employees are required to consider equity in their decisions, processes, and day-to-day work, including how their work may affect the people and communities we serve.
• The ability to take action to learn and grow – You take action to learn and grow by seeking new perspectives, learning from experiences, and using what you’ve learned to continuously improve how you work and serve others.
• The ability to take action to meet the needs of others – You take action to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and solutions that support the people of the communities we serve

Preferred qualifications:

• Demonstrated ability to use computer systems and applications, including ACES, ProviderOne (P1), and Siebel, to research information, document interactions, and support customer service activities.
• Demonstrated experience applying knowledge of Medicaid programs, policies, procedures, and related requirements to accurately respond to customer and provider inquiries.
• Demonstrated ability to consistently provide excellent customer service in a high-volume, toll-free customer service center while managing continuous phone calls throughout a full work shift.
• Demonstrated ability to research, interpret, and communicate information involving conflicting or changing rules, policies, procedures, and program requirements, including changes originating from other programs or business areas.
• Demonstrated ability to manage stressful and complex customer interactions, resolve issues within established timeframes, and professionally communicate with customers when expectations differ from applicable policies, regulations, or Washington Administrative Code (WAC) requirements.
• One of the following education/experience combinations:
  • Bachelor’s degree and one (1) year of experience providing direct client services or counseling of customers in the areas of health insurance, disability, or other related health benefits; public assistance eligibility determination; health insurance premiums/claims processing, adjusting, and investigation; other medical premiums/claims/eligibility related experience; or experience researching and analyzing complex rules, regulations, or policies and utilizing research and analysis to make determinations, solve problems, or complete work while providing direct customer service either in person or on the telephone; or
  • Associate degree and three (3) years of experience as described above; or
  • Five (5) years of experience as described above; or
  • One year as a Medical Assistance Specialist 2

About HCA:

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

What we have to offer:

• Meaningful work with friendly co-workers who care about those we serve Voices of HCA
• A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package WA State Government Benefits
• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
• Tuition reimbursement
• And free parking!

Notes:

This position is covered by the Washington Federation of State Employees (WFSE). Once the listed position(s) is(are) filled, this recruitment announcement may also be used to fill additional position(s) for up to sixty (60) days.

Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at View email address on apply.j-vers.com. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Jake Nelko at View email address on apply.j-vers.com or View phone number on apply.j-vers.com.

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify® is a registered trademark of the U.S. Department of Homeland Security.

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