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Benefit Specialist (Omaha, NE)
Omaha, United States
Benefit Specialist (Omaha, NE)
Summary – The Benefit Specialist determines, maintains, and terminates member and/or dependent eligibility for health care benefits. Responds to incoming telephone calls from members and providers regarding medical, dental, vision, disability and reimbursement account claims and benefits. Reviews claim data to ensure accuracy of processing in accordance with Plan provisions. Provides clerical support to the office.
Essential Duties and Responsibilities include but not limited to
- Provide clerical support to the office: inventory & ordering office supplies, monitoring & reporting postage, processing & directing incoming paper & electronic documents, preparing outgoing mailings & shipments and maintaining record organization and storage.
- Know the plan rules for eligibility and healthcare benefits as outlined in the Summary Plan Description (SPD) for each benefit.
- Professionally and accurately respond to incoming calls & electronic communications from members & providers to include, explaining benefits, eligibility issues claim status and other questions or concerns to provide problem resolution.
- Use month-end reports to determine eligibility, reinstatement and termination of health care coverage.
- Prepare and mail enrollment packages & ID cards to all newly eligible members upon member request.
- Carefully review the following reports: Month-end Calculation, Exception, Post H&W and Pension Check H&W Deduction.
- Collaborate with others department to ensure that member eligibility and claim needs are addressed, deadlines are met, and for problem resolution which is cross departmental.
- Review monthly communications to members before mailing to ensure that information is correct.
- Determine qualifying events and notify members/dependent of COBRA rights.
- Responsible for system updates and coverage changes when member’s status changes (i.e., adding dependents, disability, retirement, death, when dependents reach maximum age for coverage and become eligible for Medicare).
- Verify and maintain employee enrollment and vital information (i.e., member and dependent address, phone number, date of birth and social security numbers).
- Review and prepare incoming eligibility and claim appeals.
- Respond to requests from Plan Managers and Trustees, as requested.
- Communicate with various vendors regarding prior authorizations and eligibility issues.
- Audit, approve and respond to various vendors reports, invoices and extracts.
- Manual processing of vision claims.
- Responsible for maintaining subrogation files to include collection of all pertinent documentation, calculation of reimbursement totals, and all relative correspondence.
- Elevate concerns and/or discrepancies from office, members, vendors & clients to the Office Supervisor and Eligibility Supervisor.
- Regular and predictable attendance is an essential function of this job.
Education and/or Experience – Post high school education or prior related work experience. Familiarity with employer benefit terminology.
Language Skills – Ability to read and interpret plan rules as outlined in the SPD’s, user manuals for on-line services, department rules & procedures manual and COBRA compliance manual. Communicate well with Plan Management and higher level
Mathematical Skills - Ability to apply concepts of basic addition, subtraction, multiplication and division.
Reasoning Ability - Creative ability to continually improve processes, transmission of information and apply good communication skills both verbally & visually to translate information with ease of understanding for both our members, clients and vendors.
Physical Demands – Extended computer time.
Work Environment - Fast-paced department. Work independently as well as in a team, must be able to multi-task and be detail oriented.
Work Schedule - Full-time. Monday – Friday, 7:30am - 4:30pm. Required in office (No at-home days).
Competitive Benefits and Compensation Package
- 12 paid holidays
- Paid Time Off (PTO)
- Pro-rated during first year of employment
- 15 days of PTO provided in the next calendar year!
- 3 days paid bereavement
- Up to 20 days paid jury leave
- Medical, dental, and vision insurance, with option for dependent coverage
- Company-paid basic life, short-term disability, long-term disability, and AD&D insurance
- 401k with employer match
- Tuition reimbursement program
- Career development opportunities
- Referral bonus for all successful full-time referrals
- Annual opportunities for increases
Pay
Hourly rate ranges from $21.00 - $23.00. Actual rate dependent on location, skills, education, experience and other business factors.
Our Culture
BeneSys wants to be a great service provider to the members we serve, and we recognize we can only do that if we are also a great employer with successful employees. In short, our success is driven by our employees’ successes. We want to be a place where people want to work, feel proud of what they do and feel fulfilled both professionally and personally. We want to create a place where employees can find long-term growth and potential.
Our culture focuses on three core values:
- Collaboration: working together across 31 locations to achieve the best for the company and our clients
- Dedication: striving to create an environment where all employees work toward a common goal while committing to providing the best customer service to our members and our colleagues
- Integrity: doing what we say we will do. Upholding strong ethical and moral principles
ADA & EEO
Reasonable accommodations will be made so that qualified individuals with disabilities are able to complete the application process and, if hired, fulfill the essential functions of their job.
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