Job Information
State of Tennessee Job Information
Opening Date/Time
Thur 06/22/2023 12:00AM Central Time
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Closing Date/Time
Wed 06/28/2023 11:59PM Central Time
Salary (Monthly)
$4,975.00 - $7,458.00
Salary (Annually)
$59,700.00 - $89,496.00
Job Type
Full-Time
City, State Location
Nashville, TN
Department
Finance and Administration
LOCATION OF (1) POSITION(S) TO BE FILLED: DEPARTMENT OF FINANCE & ADMINISTRATION, BENEFITS ADMINISTRATION DIVISION, DAVIDSON COUNTY
This is a work from home opportunity
Qualifications
Education and Experience: Graduation from an accredited college or university with a bachelor's degree and experience equivalent to three years of full time professional work in one or a combination of the following: health benefits administration, health benefits claims examination, or life insurance claims examination experience.
Substitution of Experience for Education: Any health benefits or life insurance experience may substitute for the required education to a maximum of four years (e.g., experience equivalent to one year of full-time work in one or a combination of the above listed fields may substitute for one year of the required education).
Other Requirements
Necessary Special Qualifications: None.
Examination Method: Education and Experience, 100%, for Preferred Service positions.
Examination Method: Education and Experience, 100%, for Preferred Service positions.
Summary
Summary: Under general supervision, performs professional insurance benefits program evaluation and consultative work of considerable difficulty; and performs related work as required.
Distinguishing Features: An employee in this class serves as a staff specialist for an insurance administrative function, including training, and/or the interpretation of new regulations in the area of insurance benefits, to ensure State insurance benefits, policies, and procedures are properly and consistently applied. This class differs from the Insurance Benefits Analyst series in that an incumbent of the latter is responsible for explaining state insurance plans, policies, benefits, and procedures to state employees.
Responsibilities
Analyzing Data or Information:
- Researches billing issues (e.g. retroactive transactions, individual billing, retirement payroll, agency billing, deferred compensation, flexible benefits) to determine whether adjustments, refunds or additional collections are needed.
- Analyzes reports and queries to determine noncompliance, keying and payroll errors.
- Analyzes initial enrollment, dependent verification, special qualifying events, flexible benefits and deferred compensation for accuracy and to ensure they meet eligibility criteria.
- Analyzes data to ensure only eligible participants are enrolled in the Plans in compliance with the rules and regulations from Benefits Administration, Insurance Committees, and Federal and State laws.
- Analyzes work product of analysts to ensure enrollments submitted are entered correctly.
Evaluating information to Determine Compliance with Standards:
- Ensures compliance with Federal and State laws and Plan Documents.
- Ensures Benefits Administration, Insurance Committees, Rules and Regulations, Federal and State laws have been enforced and properly applied when conducting audits or reviews.
- Reviews Plan Documents, Policies and Procedures and makes recommendations for modifications based on Federal and State laws.
Interpreting the Meaning of Information for Others:
- Interprets and communicates Federal and State laws and regulations and Plan Document language affecting administration of insurance benefits (e.g. COBRA, FMLA, retirement, workers compensation) to members, agency benefit coordinators and management.
- Interprets and explains information/data to conduct audits and/or reviews.
Making Decisions and Solving Problems:
- Handles complex Benefits Administration projects and assesses problem areas.
- Identifies potential operational or systems problems by monitoring processes for quality assurance purposes.
- Reviews Benefits Administration Review Team cases to determine if the initial denial should be overturned due to information provided.
Communicating with Persons Outside Organization:
- Communicates with members, agency benefits coordinators, other agencies and vendors, in person, by phone, e-mail or written correspondence regarding eligibility, enrollment, billing and other insurance options (e.g. FMLA, workers compensation, COBRA, retirement, waiver of premiums, leave of absence).
- Provides detailed and accurate written correspondence and/or verbal information when responding to inquiries regarding coverage.
Provide Consultation and Advice to Others:
- Provides guidance and expert advice related to billing discrepancies, policies of the Plan, Insurance Committee decisions and Federal and State laws.
- Works with agency benefits coordinators and organizations to ensure that eligibility criteria are communicated accurately and timely.
Interacting with Computers:
- Utilizes mainframe and internet applications to research and process enrollments, changes and terminations (e.g. deferred compensation, flexible benefits, retirement, billing, leave, workers compensation, FMLA); track audit reviews; researches Federal and State Laws.
- Creates spreadsheets and presentations to analyze data and conduct training.
Training and Teaching Others:
- Discusses employee orientation and training materials.
- Discusses policy and procedure changes and trends, management techniques, team building techniques affecting the operational effectiveness of Benefits Administration staff with management and other personnel.
- Presents formal training lectures and demonstrations to internal and external customers.
- Makes recommendations to management on the continuance or modification of the training program.
- Develops and administers surveys and evaluations to obtain information on the quality of training sessions and to identify future training needs of personnel.
- Schedules rooms, times and trainees for training sessions.
- Tracks training attendance of Benefits Administration employees and agency benefits coordinators.
Coordinating the Work and Activities of Others:
- Sets clear expectations for each member of the group to ensure understanding of their job duties.
- Plans and coordinates the activities of team members to ensure operational and strategic priorities are met and conflicts in scheduling and responsibilities do not arise.
Updating and Using Relevant Knowledge:
- Updates work processes as required by system, procedural or policy changes.
- Reviews management communications regarding Federal and State laws and Plan Document updates and changes.
- Participates in annual required HIPPA and Fraud training.
Coaching and Developing Others:
- Performs corrective action, provides general feedback and coaches analysts as necessary.
- Administers Benefits Administration and customer service training.
- Coaches team members, peers and agency benefits coordinators on processes, policies and procedures and resources for all State Insurance Plans to ensure optimal performance management.
Organizing, Planning and Prioritizing Work:
- Manages multiple projects and work activities simultaneously while adhering to performance expectations.
- Obtains clarification from supervisor when determining priority of work.
- Schedules time to accommodate emergencies.
Communicating with Supervisors, Peers or Subordinates:
- Notifies supervisor of an escalated situation or irate member, peer or team member.
- Reviews all correspondence (letters, faxes and e-mails) for spelling, tone and grammar accuracy.
- Provides feedback to supervisor regarding peer and team member performance.
Competencies
Competencies:
- Ethics and Values
- Integrity and Trust
- Problem Solving
- Organizational Agility
- Customer Focus
- Time Management
- Perseverance
- Decision Quality
- Learning on the Fly
- Dealing with Ambiguity
- Customer Service
- Microsoft Office, Enterprise Resource Planning (ERP), databases
- Communication and Training Techniques
- Methods and Techniques of Research, Analysis & Report Presentation
- English Grammar, Spelling and Pronunciation
- Financial Analysis
- Health Benefits Administration
Skills:
- Active Listening and Learning
- Critical Thinking
- Writing, Speaking and Reading Comprehension
- Adapting to Changing Situations
- Evaluating and Solving Complex Problems
- Learning and Instructing Techniques and Strategies
- Monitoring Processes and Performance
- Systems Analysis and Evaluation
- Time Management
Abilities:
- Deductive and Inductive Reasoning
- Prioritize Tasks and Meet Deadlines
- Written and Oral Comprehension
- Written and Oral Expression
- Speech Clarity and Recognition
- Retention of Policy and Procedural Information
- Comprehension of Abstract Concepts and Application to Work Situations
- Multitasking
Tools & Equipment
- Personal Computer
- Telephone
- Fax Machine
- Printer
- Scanner
- Copier
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