Benefits Specialist - Insurance Services

Position Summary

Under the general supervision of the Executive Director, serves as a key technical and informational contact between Medical, Dental, Vision and Pharmacy carriers, school district personnel, members and providers. Performs a variety of complex clerical, data processing and/or technical accounting work involved in developing, maintaining and auditing data sets specific to their department and serves as a resource to the Humboldt County Office of Education (HCOE), school district and charter staff. This position oversees the work of the Benefits Clerk.

Distinguishing Characteristics

This is a mid-level position. A specialist is responsible for the collection, reconciliation and reporting of specialized groups of data. They work with complex data and perform technical and clerical duties specific to their assigned department. A specialist serves as a technical resource to member districts, prepares and provides training and support in both one-on-one and group settings, clearly communicating complex processes.

Supervision Received and Exercised

The Benefits Specialist works under the supervision of the Executive Director of Insurance Services. This position oversees the work of the Benefits Clerk.

Examples of Duties and Responsibilities

• Conductsmember trainings, employee open enrollment meetings and individual member benefits consulting sessions;
• Serves as primary system design and technical contact for enrollment management software system, assisting the Executive Director in the design and content management of member forms, training materials and website;
• Develops tools for member district benefits support;
• Manages customized database program involving rates, plans, plan descriptions, subscriber information, change updates and member problems;
• Coordinates the implementation of plan changes for members and processes enrollment/change forms using custom web-based computer systems;
• Reviews monthly bills and eligibility lists for districts; collects and processes data for monthly financial reports;
• Compiles and prepares monthly financial reports;
• Reviews and audits Summary Plan Description Books and Summary of Benefit Coverage sheets annually, noting changes, errors and inconsistencies for each plan;
• Reviews and addresses CMS Medicare demand letters;
• Coordinates, in conjunction with the Director, the initiation of open enrollment;
• Assists members in implementing, managing and understanding dependents eligibility requirements;
• Coordinates exception forms and related issues concerning retro-active changes requested by districts;
• Responds to inquiries concerning benefits coverage, changes, policies and timelines;
• Receives, processes, reviews for accuracy and evaluates employee/subscriber enrollment and a variety of other forms and applications;
• Explains and assists employees with completion of enrollment forms;
• Establishes and maintains employee/subscriber records and files.

Qualifications

Knowledge of

• Departmental principles and practices.
• Concepts and techniques related to the research, gathering, compiling, auditing and processing of specific sets of data.
• Principles and practices of training and providing work direction as part of a team.
• Offices practices, methods and procedures.
• Computer database systems and computer-based systems.
• Medical billing and coding systems.
• Insurance documents and the ability to read and interpret Summary Benefit Description booklets;
• Federal HIPAA privacy laws and Affordable Care Act regulations.

Ability to

• Prepare, process and verify data and report information rapidly and accurately at an acceptable standard of efficiency and to meet assigned timelines;
• Analyze information and statistics and prepare reports, specifications and correspondence;
• Make recommendations regarding improved policies and procedures;
• Audit the record keeping work prepared by other personnel;
• Follow written and oral instructions;
• Work independently with little direction;
• Prepare, organize and maintain records and files;
• Present complex technical information to individuals and both small and large groups effectively;
• Professionally represent the office to other schools, businesses and agencies, as necessary;
• Adjust to changing work demands including, but not limited to, changes in procedures, technologies and fluctuations in work flow;
• Communicate effectively both orally and in writing and in one-on-one scheduled online meetings, as needed;
• Establish and maintain effective working relationships with those contacted in the performance of duties;
• Read well enough to read fine print.

Education and Experience

• Associates degree in a related field or equivalent and two (2) years of experience OR
• Four (4) years of experience, with increasing responsibility in the field of benefits Administration, health insurance or related work.

Working Conditions

This position may require travel to/from other HCOE work sites.

Environmental Elements

The employee is expected to work closely with fellow department employees, district personnel, professionals and outside agencies, in person, via email and on the telephone. This position will be assigned to an office setting where the employee may be required to walk, stand or conduct work where there are interruptions, varied temperatures, public interaction or upset staff or district members.

Physical Demands

• Long periods of time spent in front of a computer;
• Hand, finger and wrist dexterity to operate a computer keyboard and other standard office equipment.

Other Requirements

• Must be fingerprinted and a satisfactory Department of Justice records check must be received by HCOE prior to employment.
• TB testing and/or risk assessment will be required upon employment.
• Must pass a pre-employment physical (if applicable).
• May be required to obtain first aid and CPR certificates within the first 6 to 12 months of employment.
• May be required to drive with or without students; some positions may require a California driver's license, proof of insurance and possible participation in the DMV PUll Notice Program once employed.

Range: 15

Reviewed and upgraded by Commission: June 11, 2019

Modified 08/2024

PC Approved: 08/13/24