INSURANCE BENEFITS ANALYST 2* - 03252025-66417

Job Information

LOCATION OF (3) POSITION(S) TO BE FILLED: DEPARTMENT OF FINANCE & ADMINISTRATION, BENEFITS ADMINISTRATION DIVISION, DAVIDSON COUNTY

This position is designed as Hybrid

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Qualifications

Overview

Distinguishing Features: This is the working level class in the Insurance Benefits Analyst sub-series. An employee in this class performs a variety of professional insurance benefits duties such as interpreting and explaining policies and procedures of the State Group Insurance Program, the Local Education Insurance Program, and the Local Governmental Plan. This class is flexibly staffed with and differs from Insurance Benefits Analyst 1 in that an incumbent of the latter functions in an entry level capacity. This class differs from the Insurance Benefits Analyst 3 in that an incumbent of the latter functions in an advanced working level and/or lead capacity and performs work of greater scope and complexity.

Responsibilities

1. Analyzes billing transactions (e.g., retroactive transactions, individual billing, retirement payroll, agency billing) and communicates results to member or appropriate staff.
2. Analyzes and researches to determine if recoupments of ineligible claims need to be collected and contact head of contract for repayment.
3. Conducts Quality Assurance audits to ensure quality standards are being met within the policies and procedures of Benefits Administration guidelines.
4. Analyzes submitted insurance enrollments, dependent verification, and special qualifying events for eligibility and accuracy.
5. Analyzes data matches to identify inconsistencies in keying; notifies service center to update or correct system.

1. Interprets state and federal laws and regulations and the Plan Document affecting the administration of benefits to members and agency benefit coordinators.

1. Provides guidance and advice to members and agencies on billing inquiries, policies of the Plan, Insurance Committee decisions and federal and state laws.

1. Asks detailed questions of caller to properly investigate the issue presented. Utilizes a variety of resources to verify or research the information and provide the caller with the appropriate response.

1. Communicates accurate and detailed information to members, agency benefits coordinators, other state agencies and vendors in person, by phone, email, or written correspondence regarding eligibility, enrollment, billing and other insurance options.
2. Confirms plan member eligibility for outside vendors and other entities, such as pharmacists and doctors offices.

1. Utilizes mainframe and internet applications to research and process enrollments, changes, and terminations; researches federal and state laws.
2. Creates spreadsheets to analyze data.
3. Monitors call volume to assist in providing the most effective customer experience.

1. Ensures compliance with federal and state laws and Plan documents.
2. Investigates issues assigned by management team and determines appropriate solution.
3. Informs management of administrative error exception requests.

1. Documents details of calls, inquiries, and transactions regarding eligibility and enrollment applications; maintain electronic and/or hard copy documentation.
2. Maintains information on confidential open case files due to potential fraud; maintains electronic copy on secure drive once case has been closed.
3. Prepares and maintains official insurance records.

1. Manages multiple projects and work activities simultaneously while adhering to performance expectations.
2. Obtains clarification from manager when determining priority of work.

1. Notifies supervisor of an escalated situation or irate member, peer or team member.

1. Updates work processes as required by system, procedural, or policy changes.
2. Reviews management communications regarding federal and state laws and Plan Document updates and changes.
3. Participates in annual required HIPAA and fraud training as well as other customer service training and related activities.

1. Attends regular team member meetings to ensure consistent application of policies and procedures.
2. Maintains effective relationships with coworkers and agency benefits coordinators by providing timely and accurate response to their inquiries and concerns.

Competencies (KSA's)

1. Integrity and Trust
2. Ethics and Values
3. Customer Focus
4. Problem Solving
5. Technical Learning
6. Intellectual Horsepower
7. Dealing with Ambiguity
8. Approachability
9. Perseverance
10. Organizational Agility

1. Intermediate knowledge of customer service
2. Intermediate knowledge of English grammar, spelling, and pronunciation
3. Intermediate knowledge of Health Benefits Administration
4. Intermediate knowledge of Microsoft Office
5. Intermediate knowledge of applicable databases
6. Intermediate knowledge of methods and techniques of research, analysis, and report presentation
7. Intermediate knowledge of mathematics
8. Basic knowledge of financial analysis

1. Intermediate evaluating and problem solving skills
2. Intermediate reading comprehension skills
3. Intermediate speaking skills
4. Intermediate writing skills
5. Intermediate critical thinking skills
6. Intermediate self directed skills
7. Intermediate adapting to changing situations skills
8. Intermediate active learning skills
9. Intermediate active listening skills
10. Intermediate service oriented skills
11. Intermediate time management skills
12. Intermediate mathematics skills
13. Basic negotiation and influencing others skills

1. Prioritize tasks and meet deadlines ability
2. Speech clarity ability
3. Speech recognition ability
4. Retention of policy and procedural information ability
5. Oral expression ability
6. Written expression ability
7. Oral comprehension ability
8. Written comprehension ability
9. Problem sensitivity ability
10. Deductive reasoning ability
11. Inductive reasoning ability
12. Multitasking ability
13. Comprehension of abstract concepts and application to work situations ability

Tools & Equipment

1. Personal Computer
2. Telephone
3. Fax Machine
4. Printer
5. Scanner
6. Copier