Job Title (Date): Health Care Specialist
Department:
Health Care Services
Employee Type:
Full-time
Reports to: Supervisor - Disability & Service Credit Purchase
FLSA Status:
Non-exempt
Travel Required:
None
Supervisory Responsibility:
None
Salary Range: $43,700 - $61,180
Posting Period:
October 4, 2024 - October 17, 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
Desired Educations, Skills, and 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 on Service - Employee demonstrates dedication to delivering service that meets or exceeds the needs and satisfaction of our members, retirees, employers, and fellow employees. Actions and decisions put the needs of the customer first. Establishes and maintains effective relationships with customers and seeks feedback to use for improvement. Accountability - Takes personal responsibility for one’s work in both successes and failures. Shows commitment and dedication in one’s work. Follows through on all projects, goals, commitments made to others, and all other aspects of one’s work.
Consistently shows attention to quality, accuracy, and completeness of work activities. Uses failures as opportunity to learn and grow. Attends work and arrives as scheduled. Collaboration - Interacts with others in ways that demonstrate teamwork and cooperation. Builds partnerships and works collaboratively with others at all levels of the organization to achieve goals and support ONE SERS. Acknowledges others’ contributions and considers their ideas without judgment. Focuses energy on working together to find solutions. Inclusivity - Able to work with many people with different backgrounds. Shows respect for individual differences, thoughts, and opinions of other team members and is supportive of new ideas and different perspectives shared by others. Seeks to understand through open communication and active listening. Adaptability - Able to adjust to new or changing assignments, processes, people, and environments and easily consider new approaches. Strives to find efficient and innovative ways to overcome challenges and improve current processes and work products. Takes action on opportunities to improve. Embraces change and feedback in order to be more effective, efficient, and best serve our members, retirees, employers, and fellow employees. Shows dedication to positive thinking and forward momentum when facing challenges. Strategic Leadership - Models SERS’ Leadership Pillars. Maintains a positive work environment where staff feel valued, have the needed resources to complete their work, and are motivated to do their best. Supports ONE SERS by acting and making decisions in the best interests of SERS rather than individual or department. Communicates a vision and sets clear goals and expectations that are aligned with those of the organization. Provides effective feedback and holds team accountable to performance standards. Encourages and supports creativity, innovation, and change. Invests in the success of others and is committed to developing talent and providing growth opportunities. Celebrates workplace success and achievement and demonstrates a balance between getting the work done and having fun doing it.
Disclaimer: This job description 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.
43700.00 To 61180.00 (USD) Annually
