The Pennsylvania Employees Benefit Trust Fund (PEBTF), administrator of health benefits for Commonwealth of Pennsylvania employees and retirees, has an immediate opening for an Eligibility Team Leader.

This position reports to the Eligibility Supervisor and is responsible for research and correspondence to resolve eligibility issues and for notifying appropriate persons of the outcome via correspondence, email, or telephone. The Team Leader assists the Eligibility Supervisor in the distribution of daily work to the Processors and Analysts and acts as a resource to the staff in the daily workflow requirements and interaction with peers in supporting other departments. This position also provides training and a point of technical reference for the team and performs random audits to ensure compliance with department policy and procedure. The position also serves as a point of contact for requesting and receiving information to resolve eligibility problems/issues

The successful candidate will possess the ability:

• Project a professional image of the PEBTF through various telephone interactions and delivers a high level of customer service to both internal and external customers.
• Assign daily work to Eligibility Processors and Analysts. Ensure completion of the work distributed to the team on a daily basis by monitoring progress and providing assistance where needed.
• Responsible for random audits to ensure staff are correctly following policies and reports findings to the Supervisors for follow-up.
• Strictly adhere to all HIPAA and Fund Privacy and Security policies and procedures and perform member verifications in accordance with them.
• Effectively interact with other PEBTF departments/employees by accurately, and in a timely manner, reporting issues that warrant further clarification, and/or further investigation into member issues.
• Process and analyze Eligibility forms and reports according to Eligibility guidelines and standards.
• Receive/ make phone calls to outside contacts, such as personnel, vendors, Office of Administration, or SERS.
• Prepare and submit various Eligibility reports to supervisor and/or the Eligibility Director.
• Serve as a role model to the team members; assists the management team to motivate staff to support team objectives; and assesses team member individual growth and development needs
• Assist the Director and Supervisor by:
• Distributing work and monitoring progress.
• Training new and current employees as needed.
• Coaching employees in the development of technical and customer service skills.
• Reviewing errors with employees.
• Completing tasks and projects assigned.
• Participate in departmental projects and initiatives as assigned by management Eligibility Department.
• Recommend process improvements.
• Provide thorough benefit, eligibility and statistical information on a timely basis.
• Perform other duties as assigned by PEBTF management.

These skills, knowledge and experience are required:

• High school diploma or equivalent.
• Two to four years of experience with enrollment systems and electronic eligibility file processing, automated workflow systems
• At least one year in a Team Leader role within health insurance administration and/or general knowledge of systems including data entry, workflow analysis and coaching/training.

Knowledge requirements:

• General business knowledge,

• Knowledge/experience with healthcare Eligibility policies and procedures.

• Knowledge/experience with eligibility systems, including aurtomated workflow systems

• Knowledge/experience with outgoing eligibility electronic files-and ability to accurately and efficiently analyze error reports and familiarity with fields that drive the eligibility system,

• Knowledge of health insurance programs such as Indemnity, HMO, POS, PPO, Medicare and Medicare Supplemental, Vision, Prescription, Dental, Hearing Aid, and MRP plans,

• Good verbal and written communication skills,

• Good listening skills,

• Excellent analytical skills,

• Good knowledge of the healthcare insurance industry,

• Strong interpersonal skills,

• Good organization skills,

• and Powerpoint),

• Good keyboarding skills.

• Proven experience in the use of Microsoft Office Word and Excel at the intermediate level so as to support the composition of Word documents and the development of basic Excel spreadsheets including data sort and formatting.
• Ability to work independently and follow through on initiatives
• Strong attention to detail.
• Proven Team Leader skills.

These skills, knowledge and experience are preferred:

• Knowledge/experience with PEBTF’s eligibility policies and procedures.
• Intermediate knowledge/experience with Health Rules eligibility systems including data entry, recognition of system errors, review of data integrity.
• Intermediate knowledge/experience with PEBTF’s standard eligibility transmission program including resolution of transmission discrepancies, research and resolution, process improvement.
• Experience with PEBTF Automated Workflow Processes
• Intermediate knowledge/experience with the Commonwealth’s online systems, as well as SERS, and vendor systems.
• Knowledge/experience of the Commonwealth’s online system, as well as SERS, and vendor files available to PEBTF Eligibility staff.

We offer a competitive salary commensurate with background and experience, plus an excellent benefits package at the start of employment, a 401K retirement plan, tuition reimbursement, and a professional working environment.

PEBTF, an Equal Opportunity Employer, values the diversity of our workforce and the knowledge of our people.

Job Type: Full-time

Pay: $46,800.00 - $70,553.00 per year

Benefits:

• 401(k)
• Disability insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Prescription drug insurance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• Hybrid work

Work Location: Hybrid remote in Harrisburg, PA 17111