Job Description

Under general supervision, performs professional benefits work for the Health Service System's Membership and Medical Claims Divisions and performs related duties as required. Explains the City's health, dental, vision, prescription, disability plans, Flexible Spending Accounts, and Dependent Day Care and Medical Reimbursement programs. Essential functions include: providing written and oral benefits information; advising and counseling members, retirees, and surviving spouses or domestic partners on available benefits; analyzing and resolving member claim problems; processing complex claims; initiating, compiling, calculating, and processing adjustments and manual payments; interacting frequently with staff and providing training as needed; consulting with plan providers and department representatives; researching, reconciling, and resolving employee benefits and claims issues; and conducting workshops and giving presentations.

May exercise technical and functional supervision over technical/clerical staff.

Typical tasks include:

1. Provides written and oral information to members, retirees, medical providers and other interested parties regarding active and retired employee health and welfare benefit programs.

2. Advises and counsels members, retirees, and surviving spouses or domestic partners on available benefits, pursuant to rules and regulations of the Health Service System and federal and state laws.

3. Analyzes and resolves member claim problems.

4. Processes complex claims, and disburses benefits for the Health Service System.

5. Initiates, compiles, calculates, and processes adjustments to member records, premium receivables and medical claim histories.

6. Researches, reconciles, and resolves various member problems related to membership, eligibility, premiums, and medical claims accounts.

7. Interacts frequently and provides training when necessary to subordinate staff engaged in membership enrollments, terminations, accounts receivable, collection, and medical claims adjudication.

8. Consults with plan providers and department representatives regarding the member's status.

9. Conducts workshops for potential retirees and new hires regarding benefits, plans, costs, etc. and assist with the completion of required paperwork. Gives presentations to departmental orientations.

10. Processes and collects manual payments from employees on leave of absence, under COBRA, and retirees.

11. Performs related duties and responsibilities as assigned.

Qualifications

EDUCATION: Possession of a baccalaureate degree from an accredited college or university; AND

EXPERIENCE: One (1) year of verifiable experience administering employee benefit programs including: initiating membership records, calculating benefit premiums and processing enrollment applications; processing, researching and/or adjusting benefit claims or problems and updating data; AND

Proficiency in the use of computers to perform word processing and to perform data entry/retrieval.

SUBSTITUTION: Additional experience as described above may be substituted for the required education on a year-for-year basis. Thirty (30) semester units/forty-five (45) quarter units equal one year of experience.

Essential duties require the following physical skills and work environment: Ability to work in a standard office environment.

VERIFICATION OF EDUCATION AND EXPERIENCE: Applicants may be required to submit verification of qualifying education and experience at any point during the recruitment and selection process. If education verification is required, information on how to verify education requirements, including verifying foreign education credits or degree equivalency, can be found at https://sfdhr.org/how-verify-education-requirements. Employment verification letters should be on company letterhead, stating the inclusive dates of service and positions held as it relates to the qualifying experience required to be considered for the position.  Applicants must meet the Minimum Qualification requirements by the final filing date unless otherwise noted.  The selected applicant will need to verify qualifying education and/or experience prior to being appointed into the position. Falsifying one’s education, training, or work experience or attempted deception on the application may result in disqualification for this and future job opportunities with the City and County of San Francisco.  

SELECTION PROCEDURES: After application submission, candidates deemed qualified must complete all subsequent steps to advance in this selection process, which includes the following:

• Minimum Qualifications Supplemental Questionnaire [MQSQ] - Candidates will be required to complete a MQSQ as part of the employment application. This MQSQ is designed to obtain specific information regarding an applicant's experience in relation to the Minimum Qualifications (MQ) for this position. The MQSQ will be used to evaluate if the applicant possesses the required minimum qualifications.
• Supplemental Questionnaire [SQ] (100% weight) - Candidates who meet the Minimum Qualifications and complete the MQSQ will be sent an SQ to complete and return. The SQ has been designed to measure knowledge, skills and/or abilities in job-related areas. The SQ will be rated and scored. All relevant experience, education and/or training must be on the SQ in order to be reviewed in the rating process.

Note: Candidates must achieve a passing score on the selection components described above in order to move forward in the selection process.

Additional Information

IN LINE WITH THE OFFICIAL PUBLIC HEALTH ORDER TO SLOW THE SPREAD OF COVID-19, “SHELTER-IN-PLACE” HAS BEEN ISSUED FOR ALL SAN FRANCISCO RESIDENTS THAT IS EXPECTED TO BE IN EFFECT UNTIL FURTHER NOTICE. AS A RESULT, DEPARTMENT OF HUMAN RESOURCES (DHR)’S OFFICE (LOCATED AT 1 SOUTH VAN NESS AVENUE, 4TH FLOOR, SAN FRANCISCO, CA 94103) IS CURRENTLY CLOSED TO THE GENERAL PUBLIC. IF YOU HAVE ANY QUESTIONS, PLEASE FEEL FREE TO EMAIL THE HUMAN RESOURCES ANALYST LISTED ON THIS ANNOUNCEMENT. 

SPECIFIC INFORMATION REGARDING THIS EXAMINATION PROCESS:

• APPLICATION OPENING: April 15, 2022
• APPLICATION DEADLINE: April 28, 2022
• COMPENSATION: $77,896 - $94,692 annually
• ELIGIBLE LIST DURATION: 6 months, and may be extended with approval from the Director of Human Resources.
• CERTIFICATION RULE for this eligible list will be Rule of 10.
• EXAM TYPE: CPE Combined Promotive and Entrance

All your information will be kept confidential according to EEO guidelines.

Additional Information Regarding Employment with the City and County of San Francisco:

Conviction History Disaster Service Workers Equal Employment Opportunity  Information on requesting a reasonable ADA Accommodation Veteran's Preference Seniority Credit in Promotional Exams General Information concerning City and County of San Francisco Employment Policies and Procedures Copies of Application Documents Right to Work Diversity Statement Position Based Testing Information Benefits Overview If you have any questions regarding this recruitment or application process, please contact the exam analyst, Christine salam at christine.salam@sfgov.org or (415) 557-4881.

Carol Isen - Human Resources Director

CONDITION OF EMPLOYMENT:  All City and County of San Francisco employees are required to be fully vaccinated against COVID-19 as a condition of employment. Someone is fully vaccinated when 14 days have passed since they received the final dose of a two-shot vaccine or a dose of a one-shot vaccine. Any new hire must present proof of full vaccination status to be appointed. Any new hire who will be routinely assigned or occasionally enter High-Risk Settings, must provide proof of having received a COVID-19 booster vaccine by March 1, 2022, or once eligible.

The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.