SENIOR EMPLOYEE BENEFITS REPRESENTATIVE 0427
DISTINGUISHING FEATURES OF THE CLASS
An employee in this class performs the more difficult specialized work of maintaining comprehensive employee and retiree health insurance benefits in the Employee Benefits Unit (EBU) of the Suffolk County Department of Civil Service/Human Resources. Incumbents in this position perform the more complex evaluations, calculations, eligibility determinations and problem solving tasks and are expected to work at a higher level of independence than employees in the Employee Benefits Representative class. Incumbents in this class train lower-level staff and guide them in proper procedures and in problem solving. Incumbents advise and provide information to members, dependents, third-party administrators and HMOs on issues, procedures and requirements of the various health benefit plans in accordance with 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. Work requires initiative and judgment and is performed under general, technical or administrative supervision. Does related work as required.
Trains and guides Employee Benefits Representatives regarding EBU procedures and programs;
Reviews eligibility documents and bi-weekly payroll runs for enrollment, termination and status change information and updates records in the Employee Benefits System (EBS) accordingly;
Explains regulations and procedures of various health benefit plans to members, retirees and other interested parties;
Counsels members regarding benefits options to which they are entitled;
Responds to members’ inquires and resolves a wide variety of their issues and problems;
Calculates billing, follows-up on collection and records receipts for members paying monthly premiums through COBRA,
HMOs, benefit funds, unions and outside agencies;
Reviews, approves and processes Waivers of Premiums and Statement of Disability requests;
Recoups overpayments of Medicare Part B premiums and claims incurred by ineligible members;
Processes and distributes material to custodial parents and tracks information ensuring compliance with court ordered Qualified Medical Child Support Orders according to court deadlines;
Using EBS, prepares financial reports and various regulatory reports including compliance related reporting in accordance with HIPAA rules and regulations;
May assist in making benefits presentations at new employee orientation sessions.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS
Good knowledge of Suffolk County’s various employee health insurance plans including the County’s Employee Medical Health Plan (EMHP) and HMO plans; ability to coordinate benefits between these plans and Medicare; good knowledge of methods used in preparing fiscal and statistical reports; good working knowledge of the County’s Employee Benefits System; general knowledge of government regulations and laws governing health insurance plans including HIPAA, FMLA, PPACA, COBRA, 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; ability to exercise independent judgment and initiative in providing guidance to unit staff and in making eligibility determinations; ability to express oneself clearly and concisely orally and in writing; physical condition commensurate with the demands of the position.
Graduation from a standard senior high school or possession of a high school equivalency diploma recognized by the New York State Education Department and four (4) years of experience in employee benefits administration including health insurance reporting and record keeping utilizing a computerized employee benefits 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.
Two (2) years of permanent competitive status as an Employee Benefits Representative.