Job Title (Date):
Health Care Specialist (June 2024)
Department:
Health Care Services
Employee Type:
Full-time
Reports to:
Supervisor – Health Care Operations and Outreach
FLSA Status:
Non-Exempt
Travel Required:
None
Supervisory Responsibility:
None
Salary Range: $42,510 - $59,514
Posting Period:
June 14, 2024 – June 27, 2024
*Typically, initial wage is set between the minimum and the midpoint of the salary range depending on the employee’s qualifications and experience.
Summary of Responsibilities:
The Health Care Specialist is responsible for reviewing and managing member documentation from multiple sources, providing member correspondence and high-quality customer service. The incumbent is also responsible for working in collaboration with the Supervisor– Health Care Operations and Outreach to process all categories of member enrollment and billing changes and reporting.
Essential Duties and Responsibilities:
- Provides high quality customer service and supports the Member Support Team (MST) as point of contact for complex member calls and issues
- Responds to member and inter-departmental inquiries concerning SERS health care benefits by phone, mail or e-mail
- Assists Members/Retirees with understanding their health care benefits.
- Processes enrollments, plan changes, and premium billing in accordance with established procedure
- Process reports both internal and from vendors, as needed
- Reports potential problems identified from phone calls and work processing
- Prioritize work and complete processing requests meeting deadlines
- Composes and sends out routine correspondence
- Prepares and responds to correspondence regarding member and retiree enrollment including daily e-mail and faxes
- Assist Members/Retirees with inquiries regarding health care benefits in office appointments
- Resolves CMS reported issues from vendors in accordance with established procedure
- Accurately prepares outgoing mail packets and correspondence, including e-mail and faxes
- Documents all business transactions and member contacts
- Assists with review and documentation of work procedures
- Serves as backup Auditor as requested
- Serves as backup to Senior Health Care Administrative Specialist
- Identifies and communicates departmental issues and participates in resolution
- Serves on committees and work groups as requested
- Represents department as needed for various organizational initiatives and projects
- Maintains knowledge of health care plans and enrollment procedures through attending department staff meetings, in-service education, and self-learning
- Offers suggestions for process improvement.
- Other duties as assigned
Educations and Skills/Qualifications:
- Associate's degree (A.A.); or
- Three to five years related experience and/or training related to health insurance or benefits; with
- Demonstrated positive team-focused perspective and attitude
- Excellent problem-solving skills
- High attention to detail and accuracy
- Task, timeline, and results oriented
- Efficient time management skills
- Ability to use computers effectively and efficiently
- Effective communication skills
- Excellent customer service skills
- Ability to build and maintain effective relationships
- Equivalent combination of education and experience.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Working Conditions:
This role operates in a professional office environment and is subject to prolonged periods of sitting or standing at a desk and working on a computer. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines and may need to be able to lift up to 10 pounds at times. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
The hours for this position are 8:00 a.m. – 4:45 p.m.Health Care Services staff members are eligible to work remotely 2 days per week, after training and 30 days of employment. Remote working days are not guaranteed and subject to change based on organizational needs.
Competencies:
SERS Specific:
Focus - Dedicated to meeting the needs of customers both internal and external. Talks, acts, and makes decisions with customers in mind. Accountability - Takes responsibility for all work activities and personal actions; follows throughon commitments, implements decisions that have been agreed upon; maintains confidentiality with sensitive information; acknowledges and learns from mistakes without blaming others. Recognizes the impact of one’s behavior on others.Communication - Creates an environment of open, direct and proactive communication, both written and verbal.
Is unafraid to communicate freely across layers of the organization.Collaboration- Develops cooperation and teamwork while participating in a group, working toward solutions which generally benefit all involved parties.Innovation - The commitment to search for and create new and innovative approaches to activities that enhances performance. Is willing to change.
Position Specific:
Note: While performing the duties of this job, the employee is regularly required to sit, stand, walk, and lift up to 10 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. SERS is an equal employment opportunity employer.Disclaimer: This job posting is not meant to be all-inclusive and the position itself is subject to change.SERS is an Equal Employment Opportunity Employer.
We recruit, hire, train, and promote without discrimination due to age, race, color, religion, sex, sexual orientation, national origin, citizenship, disability, military leave or veteran status, genetic information, or any other status protected by applicable federal, state or local law. SERS is committed to ensuring all applicants can successfully submit an application for consideration. If you have a disability, and you wish to discuss potential accommodations to complete your application for employment, please call (614) 340-2255.
SERS does not accept unsolicited recruiter and agency resumes and will not pay fees to any third-party agency or company that does not have a signed agreement with SERS.
42510.00 To 59514.00 (USD) Annually
