Eligibility Supervisor

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 Supervisor.

This position reports to the Eligibility Manager and is responsible for the direction of Eligibility staff assigned to meet the goal of timely, accurate, and cost-effective enrollment and disenrollment of Fund subscribers. The Eligibility Supervisor interacts with internal PEBTF employees and outside members and business partners. This position participates in the planning and development of unit goals, and motivates assigned employees to meet established goals.

The successful candidate will possess the ability:

• Interact with Trust Fund personnel at all levels of the organization to coordinate and deliver high quality Eligibility services.
• Support the Implementation of an Eligibility strategy which is aligned with the corporate mission, values and strategy and translate these concepts into action through policies, programs, and processes related to meaningful information to make appropriate management decisions.
• Communicate, in partnership with Senior Management, a clear mission, strategy and values which will ensure employee ownership for fiscal responsibility and customer service.
• Act within the scope of authority and consistent with Fund objectives, guidelines, policies, and practices.
• Monitor performance of direct reports and provide prompt and objective coaching and counseling.
• Review the performance of staff on at least an annual basis or more frequently if required.
• Ensure that the PEBTF’s management principles, policies, and programs are consistently applied. In conjunction with the Human Resources Director, approve progressive discipline actions initiated by direct reports.
• Support the implementation of short and long range department goals, objectives, policies and operating procedures.
• Ensure compliance with HIPAA regulations and corporate Privacy and Security policies.
• Ensure that effective communications are maintained within the areas of responsibility. Where appropriate, inform employees as to plans and progress. Conduct employee meetings at regular intervals.
• Ensure optimum performance of the function. Recommend/implement techniques to improve productivity, increase efficiencies, cut cost, take advantage of opportunities, and maintain state of the art practices.
• Keep abreast of current trends and practices in the Enrollment/Eligibility fields.
• Monitor incoming workload and assure appropriate distribution of work based on priorities, productivity levels, and variations in workflow in order to meet departmental goals and benchmarks.
• Monitor/offer improvements to methods and procedures to meet departmental goals for basic enrollment and disenrollment and certification processing.
• Analyze the effect of policy and procedural changes upon the unit and recommend modifications or corrective action when appropriate.
• Assign staff to meet fluctuating workloads and analyze unit staffing requirements to meet current and future volumes.
• Communicate by letter or telephone with personnel offices and members on eligibility issues.
• Research/analyze procedures and written and statistical reports relative to current or future unit functions.
• Motivate/develop staff to perform their job functions at a high level of efficiency and accuracy.
• Collaborate with the Quality Assurance and Training department in preparing internal training materials.
• Conduct team meetings in order to keep staff apprised of Fund news and identify training needs.
• Assist subordinates in the resolution of problems that administratively require supervisory intervention.
• Approve/direct the efforts of the team leader in terms of training, supporting staff by addressing technical questions, creating and maintaining logs, etc.
• Represent the Eligibility department and unit on various committees or task force projects as assigned.
• Review job procedures and recommend changes as appropriate.
• Resolve production, planning, scheduling, and personnel problems.
• Prepare performance documents to submit to the Manager.
• Interview and select candidates for open positions.
• 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.
• 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.
• Willing to work hours of operation on a flexible schedule as needed to support the team schedule and additional work hours as needed to support special projects and assignments.
• Travel is negligible.

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,
• Excellent PC skills including Microsoft Office 365 tools (Outlook, Word, Excel and Powerpoint),
• Good keyboarding 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: $55,265.00 - $84,070.00 per year

Benefits:

• 401(k)
• AD&D insurance
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Prescription drug insurance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Work Location: Hybrid remote in Harrisburg, PA 17111

Salary : $55,265 - $84,070