Benefits Customer Service Analyst

Overview

Answers inquiries primarily through telephone communications with a high level of quality customer service. Prepares pre-notification documentation for medical procedures and various prescription drugs. Maintains benefit eligibility information for associates and retirees in multiple systems. Handles all responsibilities in accordance with the Plan provisions, department policies and various Department of Labor regulations. Works with minimal supervision and is responsible for making an established range of decisions, escalating to Manager when necessary and updating Manager on a regular basis

Responsibilities

What you will do :

• Answers associate and health care providers' requests over the telephone or through written correspondence within the time service standards set by the department. Exercises excellent customer service skills ensuring each contact is a positive experience by using a professional tone, displaying empathy as appropriate, being sincere and practicing good listening skills. Uses sound judgment when confronted with an unusual or unfamiliar request.
• Administers the Open Enrollment process involving communication with all Home Office and Field associates as well as all retirees to maintain or change their benefits for the upcoming plan year.
• Obtains medical information from associates, hospitals and doctors for pre-existing, outpatient / inpatient preauthorization reviews, second opinion determinations and concurrent reviews for inpatient admissions. Creates and updates nurse record screen on the benefits claim system including all medical information obtained from the member, hospital and physician offices. This information is vital in the nurses' daily monitoring of the patient's continued care.
• Creates and maintains benefit information for each associate, retiree and eligible family members in multiple systems used in the Benefits Department. Records must be updated timely and accurately to ensure payroll deductions are correct and medical / dental claims are processed correctly.
• Administers the prescription drug program. Maintains override information on all preauthorized prescriptions.
• Maintains compliance with applicable federal and state laws (., HIPAA) related to privacy, security, confidentiality, and protection of personal information, including, but not limited to, personal health information and personally identifiable information
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

Work Setting / Position Demands :

Travel Requirements :