INSURANCE BENEFITS ANALYST 2*-022118-165919

"Students must apply using the application link"

Distinguishing Features: This is the entry level class in the Insurance Benefits Analyst sub-series. An employee in this class learns to perform a variety of professional insurance benefits duties such as interpreting and explaining policies and procedures of the State Group Insurance Program, the Local Education Insurance Program, and the Local Governmental Plan. This class differs from Insurance Benefits Analyst 2 in that an incumbent of the later performs at the working level.

 

*An applicant appointed to this flexibly staffed class will be reclassified to the next higher class in the series after successful completion of a mandatory one-year training period; inadequate or marginal performance during the training period will result in automatic demotion or termination.

This is a two part application process additional instructions will be sent via email. The second part of the application must be completed by Closing Date/Time:   Tue. 02/27/18 11:59 PM Central Time -

 

 

Work Activities:

Analyzing Data or Information: 

1. Learns to analyze billing transactions (e.g., retroactive transactions, individual billing, retirement payroll, agency billing) and communicates results to member or appropriate staff.
2. Learns to analyze and research to determine if recoupments of ineligible claims need to be collected and contact head of contract for repayment.
3. Learns to conduct Quality Assurance audits to ensure quality standards are being met within the policies and procedures of Benefits Administration guidelines.
4. Learns to analyze submitted insurance enrollments, dependent verification, and special qualifying events for eligibility and accuracy.
5. Learns to analyze data matches to identify inconsistencies in keying; notify service center to update or correct system.

Interpreting the Meaning of Information for Others:

1. Learns to interpret state and federal laws and regulations and the Plan Document affecting the administration of benefits to members and agency benefit coordinators.

Provide Consultation and Advice to Others:

1. Learns to provide guidance and advice to members and agencies on billing inquiries, policies of the Plan, Insurance Committee decisions and federal and state laws.

Getting Information:

1. Learns to ask detailed questions of caller to properly investigate the issue presented. Utilize a variety of resources to verify or research the information and provide the caller with the appropriate response.

Communicating with Persons Outside Organization:

1. Learns to communicate accurate and detailed information to members, agency benefits coordinators, other state agencies and vendors in person, by phone, email, or written correspondence regarding eligibility, enrollment, billing and other insurance options.
2. Learns to confirm plan member eligibility for outside vendors and other entities, such as pharmacists and doctor’s offices.

Interacting with Computers:

1. Learns to utilize mainframe and internet applications to research and process enrollments, changes, and terminations; researches federal and state laws.
2. Learns to create spreadsheets to analyze data.
3. Learns to monitor call volume to assist in providing the most effective customer experience.

Evaluating Information to Determine Compliance with Standards:

1. Learns to ensure compliance with federal and state laws and Plan documents.
2. Learns to independently investigate issues assigned by management team and determine appropriate solution.
3. Learns to inform management of administrative error exception requests. 

Documenting/Recording Information:

1. Learns to document details of calls, inquiries, and transactions regarding eligibility and enrollment applications; maintain electronic and/or hard copy documentation.
2. Learns to maintain information on confidential open case files due to potential fraud; maintains electronic copy on secure drive once case has been closed.          
3. Learns to prepare and maintains official insurance records. 

Organizing, Planning, and Prioritizing Work:

1. Learns to manage multiple projects and work activities simultaneously while adhering to performance expectations.
2. Learns to obtain clarification from manager when determining priority of work. 

Communicating with Supervisors, Peers, or Subordinates:

1. Learns to notify supervisor of an escalated situation or irate member, peer or team member. 

Updating and Using Relevant Knowledge:

1. Learns to update work processes as required by system, procedural, or policy changes.
2. Studies management communications regarding federal and state laws as well as Plan Document updates and changes.
3. Participates in annual required HIPAA and fraud training as well as other customer service training and related activities.
4. Attends regular team member meetings to ensure consistent application of policies and procedures. 

Establishing and Maintaining Interpersonal Relationships:

1. Learns to maintain effective relationships with coworkers and agency benefits coordinators by providing timely and accurate response to their inquiries and concerns.

 

Competencies:

1. Integrity and Trust
2. Ethics and Values
3. Customer Focus
4. Problem Solving
5. Technical Learning
6. Intellectual Horsepower
7. Dealing with Ambiguity
8. Approachability
9. Perseverance
10. Organizational Agility 

Knowledge:

1. Intermediate knowledge of customer service
2. Intermediate knowledge of English grammar, spelling, and pronunciation
3. Intermediate knowledge of Microsoft Office
4. Basic knowledge of Mathematics
5. Intermediate knowledge of methods and techniques of research, analysis, and report presentation 

Skills:

1. Intermediate writing skills
2. Intermediate speaking skills
3. Intermediate reading comprehension skills
4. Intermediate evaluating and problem solving skills
5. Intermediate service oriented skills
6. Intermediate self-directed skills
7. Intermediate adapting to changing situations skills
8. Intermediate critical thinking skills
9. Intermediate active learning skills
10. Intermediate active listening skills
11. Intermediate time management skills
12. Intermediate mathematics skills
13. Basic negotiation and influencing others skills

Abilities:

1. Oral expression ability
2. Written expression ability
3. Oral comprehension ability
4. Written comprehension ability
5. Prioritize tasks and meet deadlines ability
6. Speech clarity ability
7. Speech recognition ability
8. Multitasking ability
9. Problem sensitivity ability
10. Deductive reasoning ability
11. Inductive reasoning ability
12. Retention of policy and procedural information ability
13. Basic Comprehension of abstract concepts and application to work situations ability

 

 Tools and Equipment Used:

1. Personal Computer
2. Telephone
3. Fax Machine
4. Printer
5. Scanner
6. Copier

Pursuant to the State of Tennessee’s Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State’s policy to provide an environment free of discrimination and harassment of an individual because of that person’s race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran’s status or any other category protected by state and/or federal civil rights laws.