SENIOR BENEFITS ANALYST - 72002415

State of Florida

6d•$44,000•Onsite

About The Position

The Department is seeking a motivated professional to serve as a Senior Benefits Analyst in the Member Services Section within the Bureau of Contracts and Member Services. The incumbent will be responsible for direct member and customer service support regarding eligibility and enrollment. This position will serve as a senior level member and is critical to ensure that all program members receive world-class customer service. This position is also essential to providing support and leadership in a variety of Division projects and activities and serve as primary point of telephone contact for the division. The level of direct member and customer service support provided requires the incumbent to possess a thorough knowledge and understanding of the laws, rules, policies, and procedures governing state benefit programs, as well as the People First system and operational procedures.

Requirements

High school diploma, GED equivalent or higher from an educational institution, and a
Minimum of three years of professional work experience in a human resources position performing duties related to employer group insurance benefits or comparable.
Knowledge of using Microsoft Office, Word, Excel, and Outlook.
Ability to sit for extended periods of time.
Ability to stand for extended periods of time.
Ability to lift, push and pull up to 30lbs.

Nice To Haves

Knowledge of Florida Statutes, and policies and procedures governing the State Group Insurance Program, including Chapter 60P, Florida Administrative Code.
Knowledge of federal laws, rules and regulations governing or affecting pretax benefit programs, including but not limited to section 125 of the IRS code, COBRA, Medicare, ACA and HIPAA, etc.
Knowledge of the Florida Insurance Code and/or employee group benefits.
Knowledge of People First procedures and system.
Proficient in Microsoft Office suite.
Strong oral and verbal communication skills.
Demonstrates exemplary organizational and prioritization skills.
Displays a high level of initiative and is action oriented.
Careful attention to detail and accuracy in work products; critical thinking and intellectual curiosity.
Ability to work with a variety of stakeholders in sometimes difficult situations while maintaining professionalism and world-class customer service.
Ability to effectively and efficiently work both independently and as a contributing member of a team.
Ability to plan, organize and prioritize your own work assignments to meet deadlines.
Experience in customer service.
This position requires sedentary work with repetitive motion.
Accountability, Communication, Empowerment, Flexibility, Integrity, Respect, Teamwork

Responsibilities

Member and Customer Support:a. Level II Enrollment and Eligibility Appeals: performs research sufficient to address all issues raised in appeals; prepares proposed agency action letters for approval by director; and mails a follow-up letter if additional time to respond is needed.
Provides expert witness testimony for administrative hearings related to enrollment and eligibility appeals.
Maintains database/log of enrollment and eligibility appeals, assigns appeals, sends member appeal acknowledgement letter.
Serves as support for answering and assisting member calls to Division main telephone line.
Maintains complete and accurate record of calls received to the Division main telephone line via the DSGI Customer Service Tracker.
Researches policy questions/issues and assists with drafting policy clarification documents to provide policy guidance to People First in accordance with applicable rules and benefit provisions.
Serves as the issue resolution liaison between members and vendors such as People First, health plans, pharmacy benefits manager, and supplemental insurance plans. h. Responds to routine requests, provides technical assistance and educational information to members regarding benefits and enrollment and eligibility processing within the People First system using available resources (Plan documents, Web sites, rules and regulations, etc.).
Identifies member complaint trends and recommends educational or communication strategies to mitigate future complaints and issues.
Serves as policy and process liaison to other divisions to provide guidance, resolve issues, and improve processes.
Provides input to improve language in the Plan document, 60P rules, policy clarifications, Qualifying Status Change (QSC) event Matrix, the MyBenefits website, People First system, etc.
Works with DMS People First contract team to identify and rectify service center customer service issues. m. Assists with developing training materials and conducts educational training related to enrollment and eligibility.
Prepares letters for management’s signature and mailing.
Serves as primary support to research and respond to e-mails that come through the Department’s website and the Division of State Group Insurance (DSGI) help box.
Monitors content and resource accuracy of the myBenefits website and the Department’s DSGI website.
Assists with People First manual and system letter review and approval process.
Assists with processing Medicare Enrollment Verifications.
Provides backup support for annual Open Enrollment activities.
Travels to Open Enrollment benefit fairs when necessary.
Provide reconciliations of the State’s Disability Income Planv. Works closely with Contract managers to review all vendor communications.
Identifies trends and opportunities for improved services within member services.
Operations:a. Researches, gathers, and provides information on participant eligibility, effective dates and other data for audits, claim assessments, and routine requests by appropriate insurance vendors, etc.
Follows approved standard operating procedures for distributing correspondence and maintaining copies and documentation.
Establishes, maintains and revises standard operating procedures as needed.
Assists with enrollment and eligibility audits (spouse program, ineligible dependents, etc.).
Other Duties:Provides cross functional support to other DSGI work units and bureaus for special projects and during peak workload periods as required to support the Division’s operational needs and benefits administration processes.