EMPLOYEE BENEFITS REPRESENTATIVE 0426

DISTINGUISHING FEATURES OF THE CLASS

An employee in this class performs specialized work in the maintenance of comprehensive employee and retiree health insurance benefits in the Employee Benefits Unit (EBU) of the Suffolk County Executive’s Office. The incumbent offers guidance and information to members, dependents, third-party administrators and HMOs on issues pertaining to the various health benefit plans according to guidelines set forth in the Employee Medical Health Plan (EMHP) Benefit Booklet and various federal legislation such as, COBRA, HIPAA and the PPACA (Patient Protection and Affordable Care Act) and others. Responsibility is included for making basic eligibility decisions and calculations, including but not limited to Medicare reimbursements. Work is performed under close supervision following existing rules, regulations and procedures. Does related work as required.

TYPICAL WORK ACTIVITIES

Reviews eligibility documents and bi-weekly payroll runs for enrollment, termination and status change information and makes corresponding additions and revisions to records in the Employee Benefits System (EBS);

Explains regulations and procedures of various health benefit plans to employees, retirees, and dependents;

Determines eligibility for continuation of health benefits for members and dependents in accordance with plan documents and federal legislation;

Calculates and coordinates quarterly Medicare Reimbursement and adjustment updates in the EBS system and the annual Medicare Income Related Surcharge Reimbursement;

Provides verbal and written responses to member inquiries;

Resolves a wide variety of members’ issues and problems;

Prepares for distribution various annual mailings to update eligibility records for retirees and dependents;

Receives and sorts the Unit’s incoming mail and electronic messages sent to the general EBU mailbox and distributes them to appropriate representatives for response.

FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS

Knowledge of Suffolk County’s various employee health insurance plans including the County’s Employee Medical Health Plan and HMO plans and coordination of these plans with Medicare; knowledge of methods used in preparing fiscal and statistical reports; knowledge of the County’s Employee Benefits System; general knowledge of government regulations and laws governing health insurance plans including COBRA, HIPAA, PPACA, FMLA, etc.; ability to establish and maintain effective working relationships with County personnel, retirees, third party administrators, vendors and contract agencies; ability to effectively communicate health insurance plan information orally and in writing; ability to use judgment and initiative in making eligibility decisions; physical condition commensurate with the demands of the position.

MINIMUM QUALIFICATIONS

OPEN COMPETITIVE

Graduation from a standard senior high school or possession of a high school equivalency diploma recognized by the New York State Education Department and two (2) years of experience in health insurance administration including reporting and record keeping utilizing a computerized information system.

NOTE: Additional education from a college with federally-authorized accreditation or registration by NY State may be substituted for up to one (1) year of the above experience.

R01/16/2025

SUFFOLK COUNTY

Competitive