Apply on Employer Site

State of Florida · 5 days ago

SENIOR BENEFITS ANALYST - 72002415

Tallahassee, FL

Full-time

Onsite

Mid, Senior Level

$44K/yr - $44K/yr

3+ years exp

The State of Florida is seeking a motivated professional to serve as a Senior Benefits Analyst in the Member Services Section within the Bureau of Contracts and Member Services. The role involves providing direct member and customer service support regarding eligibility and enrollment, ensuring that all program members receive world-class customer service, and supporting various Division projects and activities.

Government Administration

Responsibilities

Level II Enrollment and Eligibility Appeals: performs research sufficient to address all issues raised in appeals; prepares proposed agency action letters for approval by director; and mails a follow-up letter if additional time to respond is needed

Provides expert witness testimony for administrative hearings related to enrollment and eligibility appeals

Maintains database/log of enrollment and eligibility appeals, assigns appeals, sends member appeal acknowledgement letter

Serves as support for answering and assisting member calls to Division main telephone line

Maintains complete and accurate record of calls received to the Division main telephone line via the DSGI Customer Service Tracker

Researches policy questions/issues and assists with drafting policy clarification documents to provide policy guidance to People First in accordance with applicable rules and benefit provisions

Serves as the issue resolution liaison between members and vendors such as People First, health plans, pharmacy benefits manager, and supplemental insurance plans

Responds to routine requests, provides technical assistance and educational information to members regarding benefits and enrollment and eligibility processing within the People First system using available resources (Plan documents, Web sites, rules and regulations, etc.)

Identifies member complaint trends and recommends educational or communication strategies to mitigate future complaints and issues

Serves as policy and process liaison to other divisions to provide guidance, resolve issues, and improve processes

Provides input to improve language in the Plan document, 60P rules, policy clarifications, Qualifying Status Change (QSC) event Matrix, the MyBenefits website, People First system, etc

Works with DMS People First contract team to identify and rectify service center customer service issues

Assists with developing training materials and conducts educational training related to enrollment and eligibility

Prepares letters for management’s signature and mailing

Serves as primary support to research and respond to e-mails that come through the Department’s website and the Division of State Group Insurance (DSGI) help box

Monitors content and resource accuracy of the myBenefits website and the Department’s DSGI website

Assists with People First manual and system letter review and approval process

Assists with processing Medicare Enrollment Verifications

Provides backup support for annual Open Enrollment activities

Travels to Open Enrollment benefit fairs when necessary

Provide reconciliations of the State’s Disability Income Plan

Works closely with Contract managers to review all vendor communications

Identifies trends and opportunities for improved services within member services

Researches, gathers, and provides information on participant eligibility, effective dates and other data for audits, claim assessments, and routine requests by appropriate insurance vendors, etc

Follows approved standard operating procedures for distributing correspondence and maintaining copies and documentation

Establishes, maintains and revises standard operating procedures as needed

Assists with enrollment and eligibility audits (spouse program, ineligible dependents, etc.)

Provides cross functional support to other DSGI work units and bureaus for special projects and during peak workload periods as required to support the Division’s operational needs and benefits administration processes

Qualification

Florida StatutesFederal lawsPeople First systemProficient in Microsoft OfficeExperience in customer serviceCommunication skillsOrganizational skillsAttention to detailCritical thinkingTeamwork

Required

High school diploma, GED equivalent or higher from an educational institution

Minimum of three years of professional work experience in a human resources position performing duties related to employer group insurance benefits or comparable

Knowledge of Florida Statutes, and policies and procedures governing the State Group Insurance Program, including Chapter 60P, Florida Administrative Code

Knowledge of federal laws, rules and regulations governing or affecting pretax benefit programs, including but not limited to section 125 of the IRS code, COBRA, Medicare, ACA and HIPAA, etc

Knowledge of the Florida Insurance Code and/or employee group benefits

Knowledge of People First procedures and system

Proficient in Microsoft Office suite

Strong oral and verbal communication skills

Demonstrates exemplary organizational and prioritization skills

Displays a high level of initiative and is action oriented

Careful attention to detail and accuracy in work products; critical thinking and intellectual curiosity

Ability to work with a variety of stakeholders in sometimes difficult situations while maintaining professionalism and world-class customer service

Ability to effectively and efficiently work both independently and as a contributing member of a team

Ability to plan, organize and prioritize your own work assignments to meet deadlines

Experience in customer service

Ability to sit for extended periods of time