Benefits Specialist - Healthcare

Job Summary:

Consultant Advisor, ERP Jessica Plemmons is recruiting this position.

email me linkedin

Our client in Valhalla, NY is seeking a benefits contractor for an 18-month contract. This position is on-site 2 days a week, remote 3 days a week.

Under general supervision, this position is responsible for the daily administration of health and welfare, retirement, and other benefit plans. Responsibilities require extensive contact with insurance carriers, employees, retirees, and benefit plan administrators, as well as the input and maintenance of accurate benefits data in the Medical Center’s HRIS database and external administrators’ eligibility systems. Does related work as required.

Examples of Work (Illustrative Only)

• Maintains and processes benefit enrollments, changes and terminations for all plans, including medical, dental, prescription drugs, vision, flexible spending accounts, COBRA and retirement;
• Maintains and updates eligibility database and ensures proper enrollment of employees based upon eligibility guidelines, terminations and changes as required;
• Provides explanations of benefit programs to employees as well as departmental representatives to facilitate the administration of these programs; 
• Responds to employee complaints or problems and reviews and researches claim issues for participants;
• Gathers and compiles data and create reports as needed with HRIS database and Excel spreadsheets;
• Communicates with representatives from insurance companies to discuss benefits and claim issues;
• Audits and reconciles benefit plan invoices and eligibility files and processes monthly invoices for payment;
• Contacts, both in writing and by telephone, insurance carriers, employees and eligible former employees to ensure implementation of, and compliance with, program requirements as well as for resolution of unusual problems; 
• Provides necessary data concerning enrollments, terminations, leaves without pay, and Medicare reimbursement claims as required; 
• Analyzes and interprets new or revised requirements or programs for the purpose of determining their impact upon existing administrative and procedural activities; 
• Assists in the coordination of annual enrollment for plan participants, ensuring all changes are processed correctly; 
• Assists in the annual change of health benefit option open enrollment campaign and ensures that all appropriate changes in enrollment status are recorded and processed accurately.

Required Knowledge, Skills, Abilities and Attributes

Good knowledge of various health insurance and retirement programs, including benefit limits, eligibility criteria, and administrative and procedural requirements; good knowledge of governmental, provider and hospital rules, regulations, agreements and procedures that affect benefit programs; good knowledge of basic medical and insurance industry terminology; knowledge of third party and medical provider billing and payment procedures; knowledge of Medicare procedures and benefits; ability to evaluate and analyze potential program problem areas and to formulate and recommend workable solutions; ability to communicate effectively both orally and in writing; ability to gather and organize pertinent data and to draw appropriate conclusions; ability to establish and maintain effective working relationships; ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position; ability to use computer applications such as spreadsheets, word processing, e-mail and database software; tact; good judgment; integrity; resourcefulness; physical condition commensurate with the demands of the position. 

Minimum Acceptable Training and Experience

High school or equivalency diploma and eight years of experience performing employee benefits functions and assisting in the administration of health insurance plans, which included responsibility for identifying problems, obtaining and analyzing relevant information, and determining solutions. 

Substitutions: Satisfactory completion of 30 credits* toward a Bachelor’s degree may be substituted on a year-for-year basis for up to four years of the above-stated experience. 

To learn more about this and other positions, contact Jessica Plemmons at 678-593-3331 or jessica.plemmons@healthcareitleaders.com. Healthcare IT Leaders is a national leader in IT workforce solutions, connecting healthcare provider, payer and life sciences organizations with experienced technology talent for consulting and full-time hiring. For more information, visit us on the web at www.healthcareitleaders.com.