Benefits Manager

BENEFITS MANAGER POSITION JOB DESCRIPTION
Medical & Prescription

Candidates should send: Cover Letter, resume, and three professional references to SusanLasuen@iii-a.org by end of day Wednesday, March 25th. Interviews will be held March 30th & 31st.

This position works from home. Travel to meetings and conferences several times per year is required. The typical work schedule is Monday through Friday. The position is full-time at 40 hours/week, on call on scheduled weekends, evenings, and some holidays will be required.

III-A is an Idaho public agency and employees are enrolled in PERSI.

FLSA Designation: Non-Exempt; Salaried

Position Overview

The Benefits Manager supervises the administration of health care benefits for members of the Trust. Primarily responsible for educating members regarding their health benefits and wellness programs, resolving complex benefits issues, reviewing new benefits, data reports, creating benefit analysis, and ensuring plan designs/document correctly represent the benefit coverage. Benefits administered by the Trust include medical, dental, vision, mental health, internally processed programs, and a robust wellness program.

This position is the Trust expert regarding the Medical and Prescription Plans and is the primary contact for the Third-Party Administrators and Consultants for these programs. This includes ensuring plan documents and materials correctly represent the benefit coverage.

Providing excellent benefits and customer service to the members of the Trust is critical. This is the most important value III-A provides to the members—the individual, personal service given to members. The Benefit Manager’s responsibility is to ensure this level of service to the members.

The Executive Director is this position’s direct supervisor.

Essential Functions and Responsibilities

· Expected to handle highly sensitive and confidential information and data including HIPAA protected PHI.

· Builds relationships with III-A members; Integral in providing caring service and advising members.

· III-A expert and resource for Medical and Rx benefit administration; serves in an advisory capacity to the Executive Director regarding TPA and PBM services.

· Coordinates with TPAs, providers, and facilities when necessary, regarding benefit programs. Meets regularly with TPA account leaders regarding benefit and customer service issues.

· Primary coordinator and conducts onsite employee benefit meetings, open enrollments meetings, and delivers benefit information materials to educate agencies and members.

· Provides benefits administration by managing the day-to-day assistance to members regarding health care benefit programs and facilitates resolutions to issues and responds to eligibility and benefits inquiries.

· Assists with the III-A Benefits Line calls through the week and on scheduled evenings, weekends, and holidays.

· Reviews data reports with the Data Director and collects the information regarding the Care Management program provided to the Data Director.

· Reviews data reports to analyze what cost savings or care could be provided to members and agencies within the Trust.

· Reviews and ensures terms and conditions of the Medical and Prescription plan documents are accurate prior to submission for approval to Idaho Department of Insurance; distributes documents and required annual forms to III-A agencies.

· Reports member or agency requested benefit changes to the Executive Director and Data Director to be evaluated as a future enhancement. Prepares written benefit reports for presentation to committees and/or Trustees.

· Prepares documentation for resolution of complex customer service problems and problems related to members’ claims and prior authorization issues. May present issues to Executive Director and the Medical Review Committee in the form of a business case; periodically presents materials to the Board of Trustees.

· Supervises the Infusion Medication Program and coordinates with facilities and contractors for the delivery of meds and treatment of enrolled members.

· Assists Data Director with Workers Compensation issues.

· Accompanies Executive Director to meetings with TPA and PBM; prepares and presents information, complaint issues, and suggestions for improvement of processes and communication if requested.

· Oversees and updates the Complaint Log as required by DOI.

· Assists the Executive Director with completing risk charts for potential agencies by reviewing the medical condition of each employee and dependent from medical questionnaires provided; makes risk recommendations to the Executive Director. Accurate risk assessment of known factors is critical to the stability of the Trust.

· Reviews data to assist with creation and implementation of programs for cost saving on medical and prescription claims. Coordinates formulary prescription changes for new members.

· Attends conferences, committee meetings and Trustee meetings, and prepares/presents information as requested.

· Performs other duties as assigned.

Required Skills & Proficiencies:

• Strong skills and history in providing excellent customer service.
• Knowledge of HIPAA and PHI regulations
• Knowledge of medical, dental, and vision benefit plans required.
• Knowledge of internal operations of insurance carriers and PBMs preferred.
• Experience assessing medical costs associated with risk factors preferred.
• Ability to work with internal and external processes at all levels of benefit administration preferred.
• Strong verbal and written communication skills.
• Ability to work at a strategic level.
• Analytical skills and detail-oriented, with strong organizational skills.
• Ability to easily engage and teach individuals. Extraordinary customer service skills.
• Creating and Presenting Data and Reports to Groups Preferred
• QuickBooks, Excel, Word, Publisher, and PowerPoint Preferred
• Deadline-Oriented, Self-Motivated, Reliable

Experience and Training:

• High School Diploma or Equivalent Required.
• Associate or bachelor’s degree In Business or a Related Field Preferred.
• Five (5) years of experience in benefits; or any equivalent combination of experience and training which provides the knowledge and abilities necessary to perform required duties and tasks.

Physical Requirements

Sufficient clarity of speech and hearing or other communication capabilities, with or without reasonable accommodation, which permits the employee to discern verbal instructions and communicate effectively on the telephone and in person.

Sufficient visual acuity, with or without reasonable accommodation, which permits the employee to comprehend written work instructions and review, evaluate, and prepare a variety of written/typed documents and text materials.

Sufficient manual dexterity, with or without reasonable accommodation, which permits the employee to operate standard office equipment, including a personal computer, and operate a motor vehicle.

Sufficient personal mobility, flexibility, agility, and balance, with or without reasonable accommodation, which permits the employee to sit and work at a keyboard for an extended period of time, lift up to 30 pounds, and work in an office environment.

Special Requirements:

· Valid Idaho Drivers’ License

· In force comprehensive auto insurance policy

· Employee must be able to successfully pass a background check including driving record and criminal history check

Job Type: Full-time

Pay: From $60,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work Location: In person

Salary : $60,000