Under general supervision, performs a wide variety of duties in support of the employee benefit and/or risk management programs; assists leadership in planning, developing, implementing and maintaining employee benefit and risk programs; resolves complex and difficult eligibility, payment and other technical issues. The desired candidate will be a self-starter who exhibits both the curiosity and resourcefulness needed to assist in the development of new approaches and processes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Gathers data and reviews policy provisions and resolves complex and difficult eligibility, coverage and payment problems
• Coordinates with plan administrators and managers regarding appropriate benefit booklet language; updates plan booklets; writes brochures and publicizes insurance provisions to departments and employees 
• Applies expertise in developing processes and procedures to carry out policies and provisions of employee benefit and/or risk management program documents  Interprets and explains technical processes and provisions of employee benefit and/or risk management programs
• Assists in planning, developing, implementing and maintaining employee benefit and risk management programs to include medical, dental, life, disability, workers’ compensation and general liability 
• Advises employees, insurance carriers or administrators of action required to solve insurance eligibility and/or coverage issues; presents information on employee benefits to employee groups.
• Reviews and analyzes employee insurance benefits contract provisions, usage and trends and recommends changes to improve or restructure benefits and contract administration 
• Monitors self-funded and contracted employee benefit insurance usage, trends, expenditures and claims 
• Explain insurance coverage and claim matters to individual employees and employee groups 
• Perform complex clerical and technical tasks and schedule and organize work to meet deadlines 
• Prepare and present clear and concise oral and written reports, booklets, manuals and correspondence
• Establish and maintain effective working relationships with employees, departmental representatives, carrier and provider representatives and others contacted in the course of work 
• Inputs, assesses and analyzes employee benefit related data using a computer; prepares correspondence and reports; conducts special studies and projects
• May provide leadership over other support staff 
• Additional projects &/or tasks as needed

QUALIFICATIONS

• At least 3 years of experience working for a Health Insurance Company, or Benefits Brokerage Firm, with a working knowledge of Benefits Documentation (e.g. SPDs, Benefit Booklets, etc.) and Compliance Matters.
• A combination of experience, education and/or training which substantially demonstrates knowledge of the methods, procedures and concepts utilized in employee benefit program eligibility, coverage, payment and claims processing.
• Bachelor's degree required.

ADDITIONAL SKILLS

• Ability to interpret, understand, explain and apply a wide variety of technical insurance and related regulations, policies, rules, contracts and procedures
• Capable of leveraging internal and external resources to compile the information needed to provide guidance on Risk Management & Benefits related matters 
• Proficient in both Google and Windows based personal computer programs used in developing correspondence, documents, spreadsheets and databases 
• Basic knowledge of accounting &/or financial statements 
• Provide excellent and courteous customer service