INSURANCE EXAMINER

Job Summary:

Administers Life and Health Benefits plans for Navy Exchange and Coast Guard associates and retirees. Works closely with employees' retirees and insurance company representatives in performing job duties.

Duties and Responsibilities:

• Administers Navy Exchange System post-retirement insured life insurance medical and dental insurance programs. Reviews retirement applications and determines eligibility for post-retirement benefits in accordance with established plan provisions. Ensures appropriate benefit plan enrollment and termination forms are completed and filed with applicable carriers in a timely manner.
• Counsels both currently active and retired associates on post-retirement benefits. Provides information concerning eligibility requirements plan provisions cost etc.
• Maintains records of retired associate benefit status. Tracks and processes status changes i.e. -due to age marital status geographic relocation death etc. Responsible for ensuring appropriate payment is received for post-retirement medical benefits establishes direct deductions from retiree pension or arranges for direct payment of premiums. Audits reports and records to ensure appropriate payments are received.
• Coordinates and investigates claim and eligibility issues employees have with medical insurance carrier. Investigates claims status and provides additional information as necessary. Resolves routine issues. Refers difficult or precedent setting issues to supervisor for resolution. Maintains liaison with employee's insurance carriers and field activities regarding eligibility for benefits coordination of benefits and status of claims.
• Processes applications and statement of physical condition for part time employees applying for Optional Life Insurance Coverage. Maintains records and follows up on status. Advises associate of carrier s decision regarding coverage.
• Administers the Temporary Continuation of Coverage TCC and conversion privileges for life and health benefits plan. Counsels employees and provides enrollment forms as necessary. Tracks associate eligibility and receives and accounts for premiums paid directly to NEXCOM.
• Processes applications for participation in Life and Health Benefit Plans during biannual and annual enrollment period. Maintains records. Tracks and follows up on status of applications requiring carrier approval.
• As assigned conducts audits of benefits plan participation against payroll and carrier records. Investigates and resolves discrepancies. May reconcile HMO bills prior to payment.
• Composes a variety of routine correspondence to employees, retirees, insurance carrier etc.
• Maintains records and files in an up-to-date manner and in a format making required information easily retrievable. Ensures required paper copies of forms documents etc. are maintained in appropriate files.
• Carries out policy of courtesy and customer service. Deals with customers tactfully honestly and promptly

GENERAL EXPERIENCE: Three years of experience in administrative or other responsible work that enabled the applicant to gain general knowledge of medical dental and life insurance and benefit claims.

OR SUBSTITUTION OF EDUCATION FOR EXPERIENCE: One year of academic study above the high school level may be substituted for nine months of experience up to a maximum of a four-year bachelor's degree for three years of general experience.

AND SPECIALIZED EXPERIENCE: Six months of experience in the application and adjudication of retirement and benefits claims and the various laws regulations and provisions of an organization's medical dental and Life insurance plan or other related medical dental and life benefits claims experience of a non-clerical nature.