Benefits Analyst

Scope:

The Benefit Analyst is responsible for the efficient handling of claim adjudication of medical, vision, and short-term disability claims for members and dependents of the Fund. As well as Cost Containment and Customer Service responsibilities. The Benefit Analyst also participates in the Internal Claim Review Committee.

Duties & Responsibilities include, but are not limited to:

• Medical and vision claim processing.

• Handle short-term disability and reporting.

• Handle Subrogation matters for WHF members and non-member clinic patients.

• Maintain refund requests. Requesting, posting and referring to collections.

• Must have thorough understanding of all plans guidelines as they relate to the coverage of healthcare services as well as the eligibility rules of the Plan.

• Benefit exceptions to UHC to allow denied claims to be paid.

• Internal Claim Review Committee Appeals.

• Board of Trustees Appeals.

• Create and maintain policy and procedures.

• Handles correspondence with members and providers regarding claims processing requests for information and/or claim processing issues.

• Customer service duties via telephone, email, and face to face with members, dependents, providers, and employers. Maintains detailed telephone log and comments.

• Work with other departments of the Fund as needed.

• System training, claim processing training, and auditing.

• Cross train with all areas within the department.

• Process incoming/outgoing mail.

• Year end 1099 report.

• Perform other duties as assigned.

Experience & Education Required:

· High School diploma or equivalent

· Basic computer skills

· Insurance industry experience is preferred

· Bilingual (English/Spanish) a plus

Behavioral Skills:

· Professional and mature demeanor

· Ability to work independently and as part of a team

· Ability to handle multiple tasks with constant interruption in a timely fashion

· Excellent communication skills, both oral and written

· Must have ability to remain calm and “service-oriented” at all times

· High regard for detail and accuracy

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift
• Monday to Friday
• No nights
• Weekends as needed

Work Location: In person