Job description
Benefit Specialist (Rosemont, IL)
Summary of Position – The Benefit Specialists primary responsibility is to be the liaison between members, employers and BeneSys for healthcare questions and issues. This includes taking calls, member walk-ins, quoting benefits, updating member records as needed and processing claims.
Essential Duties and Responsibilities include but not limited to:
- Eligibility and Member Service Functions
- Act as point of contact and serve as liaison on escalated/complex member and provider issues related to claims or healthcare coverage issues.
- Know the plan rules as outlined in the Plan Document.
- Assist with member phone calls related to eligibility and claims.
- Respond to member correspondence and inquiries regarding eligibility and claims issues.
- OnBase documentation processing, consisting of but not limited to the following: collecting completed enrollment forms and adds all members & their eligible dependents to the BeneSys computer system and any/all outside carrier systems.
- Use month end reports to determine eligibility, reinstatement, and termination of health care coverage.
- Comment system when changes are made to participant record.
- Enrollment and death verifications/ processing.
- Prepare and mail enrollment packages and ID cards to all newly eligible members.
- Requests and evaluates legal documents such as divorce decrees, marriage certificates, birth certificates, etc. to determine dependent eligibility according to Plan rules.
- Determine qualifying events and notify member/dependent of COBRA rights.
- Responsible for class code and coverage changes when members status changes, such as adding dependents, disability, retirement, death and when dependents reach maximum age for coverage.
- Send proper enrollment documents to members adding children or a spouse.
- Requests missing address for members from employers.
- Verify and maintain employee vital information (i.e. member and dependent address, phone number, date of birth and social security numbers).
- Communicate with various vendors regarding prior authorizations and eligibility issues.
- Review and approve weekly eligibility extracts to be sent to carriers.
- Identifies and troubleshoots system issues related to eligibility calculations and reporting.
- Support Plan Manager/Associates as needed.
- Claims Functions
- Process H&W claims in the appropriate amount of time to ensure that member receives his payment in a timely manner according to the rules of the plan.
- Verify Loss of Time eligibility and apply credits when applicable.
- Review and respond to participant appeals.
- Maintain 98.5% financial and procedural claims accuracy.
- Monitor claims inventory and ensure claims are worked timely to meet client turnaround time SLAs.
- Work with Pension to coordinate retirement dates, to avoid overlapping payments of both pension and disability simultaneously; document disability dates to avoid overpayments; request refunds from members when overpayments are made.
- Run checks on assigned days weekly, for Disability and Death Benefits, advise Operations of these check runs; process stop payments, voids and refunds for all benefit types.
- Handle manual check runs and print checks in office when requested by a member.
- Research payments according to plan rules to respond to members requests for payment of claim. Call back member with result. Ensure the member that claim was processed correctly, and the maximum benefit was received.
- Process Death Applications and gather information needed for different Life Insurance Carriers for processing of Death Benefits.
- Support Plan Manager/Associates as needed.
- Communicate and interact effectively and professionally with co-workers, management, clients, vendors, and plan professionals.
- Perform special projects as required or requested by client and/or Executive Management team.
Required Qualifications:
- 2 years as a group health insurance account representative
- Must have previous medical claims processing experience
- Knowledgeable of medical terminology (i.e., CPT codes, ICD-10 codes, HCPCS, ADA codes) and comprehension of claims operations specifically related to third party administrators along with advanced knowledge of coding and billing processes.
- Strong interpersonal, verbal, written communication, and presentation skills.
- A self-starter with an ability to work independently and in a team environment.
- Capable of working in a fast-paced environment.
- Strong analytical problem solving and critical thinking abilities.
- Ability to work independently for extended periods while performing research and root cause analysis.
- Ability to learn and efficiently work in numerous systems and applications.
- Strong organizational and time management skills.
- Ability to prioritize workflow and set work objectives.
- Customer service oriented; detail oriented.
- Experience addressing customer needs and building customer relations.
- Experience analyzing reports and analyzing financial information.
- Regular and predictable attendance is an essential function of this job.
Supervisory Responsibilities - None
Work Schedule - Full-time, Monday - Friday 8:00am - 5:00pm. Required in office (no at-home days).
Competitive Benefits and Compensation Package
- 15 days Paid Time Off (PTO) during first full calendar-year of service
- 12 paid holidays
- 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 and bonuses
Pay
Hourly rate ranges from $25.00 - $28.00. 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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