Benefits Administration Associate - Health Plan Member Coverage
Dean Health Service Company, LLC

Job Info

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It's more than a career, it's a calling.
WI-Dean Health Plan 1277 Deming

Worker Type:
Regular

Job Highlights:

The Benefit Administration Associate provides administrative support to the health plan division related to creation and posting of member certificates, summaries of benefits and coverages and other member facing documents. This is not a human resource employee benefits administration position.

Job Summary:
The Benefit Administration Associate will responsible for the building and quality assurance of new and renewing group benefit plans in health plan's core administrative system. The person will also be responsible creating and posting DHP member Certificates, Summaries of Benefits and Coverages and other miscellaneous member facing documents. These processes are critical to ensure the accurate application and documentation of plan benefits and the correct administration of member claims.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Under the direction of the department manager and senior staff, create and maintain detailed benefit plan designs. This includes the creation of templates to assign financial liabilities to benefit plans within the claims administration system. It also includes data entry of assigned benefit plan descriptions into prescribed formats in accordance with department standards for quality and turn-around times.
• Analyze reports for quality assurance activities to ensure that the plans in production in the claims system accurately reflect detailed plan designs. Complete all benefit remediation as required through quality assurance activities, regulatory changes, and benefit configuration modifications introduced throughout the year.
• Support the creation of member facing documents including Summaries of Benefits and Coverages, Certificates of Coverage, and Schedules of Benefits utilizing Microsoft Office or other document management systems. Publish them to the Member Document Center for display on health plan websites for access by prospective and enrolled health plan members, agents, employers and health plan providers
• Support the creation and maintenance of benefit narratives for Electronic Data Interchange 270/271 transactions.
• Provide production support for questions from across DHP related to member benefits and cost share accumulators.
• Participate in intra-departmental teams, providing input into planning and quality improvement activities related to plan builds, document creation and other job related tasks.
• Review and provide input on policies/procedures that support benefit configuration in all applications that require benefit data.
• Support unit and patch testing for core administration system upgrades
• Perform training for teammates as needed on processes related to assigned functional areas.
• Performs other duties as assigned.

EDUCATION

• High school diploma or equivalent

EXPERIENCE

• Two year's experience of health insurance experience in health plan administration, claims operations or benefit administration

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

Department:
97250188 700435-Benefits, Provider and Pricing Admi

Work Shift:
Day Shift (United States of America)

Scheduled Weekly Hours:
40

SSM Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

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