Welcome to a team of caring and passionate people who work each day to meet the needs of our members and clients. At Health Benefits, you will be part of an organization committed to offering custom self-funded health benefits plans that manage costs – without compromising benefits – by offering innovative solutions, flexibility, transparency and customer support. We are now a subsidiary of Health Care Service Corporation, the largest customer-owned insurance company in the United States and a strategic partner of Health Benefits since 2018, giving us access to increased national scale and support. This is an exciting time to join our team and enhance our culture that emphasizes caring, diversity and inclusion, mutual respect, collaboration and service to our communities.  

SUMMARY:  Responsible for providing quality service by timely and accurately entering and/or modifying eligibility data in Health Benefits systems according to established procedure and Direct-to-Employer (DTE) group requirements. This position is also responsible for supporting the DTE group onboarding and renewal process including creation of group-specific documents and other tasks.

RESPONSIBILITIES INCLUDE: 

• Based upon the client’s requirements and methods of eligibility submission, review, interpret, enter, process and/or audit enrollments, terminations and eligibility change requests in a timely and accurate manner utilizing any Health Benefits system, e.g. PowerSTEPP (AS400), Real Time Eligibility/portal, Triple E reports.
• Utilize eligibility plan policies when maintaining eligibility to ensure compliance
• Review, research and respond professionally to client and broker inquires within 2 business days
• Auto-assign PCPs when required and monitor PCP patient counts per client’s rules
• Term dependent children at age 26
• Process requests for proof of coverage
• Issue and process disability requests
• Review and resolve eligibility error and audit reports
• Maintain assigned eligibility work queues according to Health Benefits procedure and turnaround time expectations
• Request ID Cards and distribute as required.
• Audit dependent eligibility, when required.
• Create and provide census report upon initial eligibility load
• Handle all tasks related to COBRA activity.
• Identify, create and provide the appropriate group documents (SBCs, plan documents, ASA (administrate service agreement), stop-loss agreements)
• Send outbound email messages to group/broker in support of onboarding & renewal process
• Archive documents signed by group
• Configure portal for new group/broker
• Other onboarding and renewal tasks as needed
• Treat all client inquiries professionally and respectfully following Health Benefits guidelines
• Research client inquiries and respond appropriately.
• Follow-up regularly on outstanding issues to ensure timely resolution and client satisfaction.
• Thoroughly and accurately document all inquiries using PowerSTEPP and Family Files following Health Benefits guidelines.
• Other duties as needed/assigned.

REQUIREMENTS INCLUDE:

• High School diploma or GED equivalent
• Minimum three years of Eligibility experience is required.
• Ability to work in a fast-paced, customer service and production driven environment
• Exceptional data entry skills with high attention to detail
• Excellent verbal and written communication skills
• Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Management staff all levels of staff
• Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
• Flexible; open to continued process improvement
• Self-directed individual who works well with minimal supervision
• Good leadership, organizational and interpersonal skills
• Prior experience with benefit enrollment or eligibility preferred.
• Prior experience in a medical office or hospital billing environment a plus.
• Insurance/Benefits and/or TPA/Carrier experience preferred.
• Ability to effectively deal with problems in varying situations and reach resolution
• Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word

Come join Health Benefits! Join a team that will not only utilize your current skills but will enhance them as well. Benefits include health/dental/vision, life insurance, FSA, and HSA, 401(k) plan, Employee Assistant Program, Back-up Care for Children, Adults and Elders and many health and wellness initiatives.  

If you are a Colorado or New York resident and this role is a field-based or remote role, you may be eligible to receive additional information about the compensation and benefits for this role, which we will provide upon request.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran, or disability.

Required Skills Required Experience

Required Skills:

EDUCATION/EXPERIENCE/SKILLS

• Bachelor's Degree in Food Science, or a related field, or equivalent amount of relevant experience and education. Food industry experience strongly preferred.
• 0-2 years of related experience is preferred.
• Planning, organizing, coordinating and leadership skills.
• Computer skills including proficiency with Microsoft Office Suite (Excel, Word, and PowerPoint).
• Ability to work with employees at all levels of the organization.
• Strong problem solving, and decision making skills.
• Demonstrated ability to communicate effectively both written and verbally.
• Ability to work in conditions, which include multiple, and sometimes conflicting priorities, extended work schedules, and specific time constraints.
• Additionally, candidate must interact well with other employees, work overtime as needed, be able to work in food manufacturing facility and adhere to all Good Manufacturing Practices

OSI believes all persons have the right to be treated with dignity and respect. It is the policy of OSI  to provide equal employment opportunity (EEO) to all persons regardless of age, national origin, gender, race, color, religion, pregnancy, gender identity, sexual orientation, protected veteran status, disability, or any other characteristic protected by federal, state or local law.  All applicants will receive consideration for employment based on merit, qualifications and business needs. OSI participates in the E-Verify program.