Enrollment Specialist I or II

About The Company

PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utah’s public employees through high quality and competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. As a government entity, we embrace both a public mission and a commitment to creating customer value, excelling in the market, and improving healthcare. We offer a competitive salary with generous benefits, personal development in a positive team environment, and excellent work-life balance. For most jobs, remote work is available for 9 out of every 10 workdays.

Job Description

This job may be filled at either of the levels listed below.

Enrollment Specialist I- Min: $16.83/hr.  Max: $21.05/yr.

Enrollment Specialist II- Min: $19.73/yr.  Max: $24.67/yr.

 

 

 

 

POSITION SUMMARY

Performs a variety of clerical duties to expedite the day to day processing of enrollments, employment status, changes and premium collections of group insurance members.

              

ESSENTIAL DUTIES & RESPONSIBILITIES

Processes member enrollment and change forms, including data entry into PEHP system, verifying proper completion of enrollment and change documentation. Requests and verifies information as needed to expedite enrollment.  Audits daily online enrollment activity and periodic electronic enrollment activity. 

Follows up with employer groups, third party vendors, brokers, and members to complete enrollment and change process. Processes and monitors COBRA, Leave, LTD, and COBRA benefits ensuring compliance with HIPAA, COBRA, FMLA, Leave without Pay status, ACA, and IRS regulations, and to maintain correct status of Subscribers and Dependents based on age, dual COB order, and other eligibility requirements.  Accesses imaged documents for historical verification in order to respond to employer groups, broker or for members.

Responds to ORS dependent orders, verifying or adding dependents

Provides certificates of coverage, COBRA information, rates and other documents as requested by members.

Provides telephone technical support for members using the PEHP online enrollment system. Provides telephone and reporting support to other internal departments, employer group HR/benefit coordinators, and brokers regarding eligibility information, plan availability, PEHP Master Policy rules, limits, HSA/FLEX eligibility/rules, claim payment, and discrepancies with enrollment

Performs comprehensive monitoring of benefit payments (eligibility, premiums, billing) to assure proper credit to employer groups and members. Monitors payroll deduction reports to ensure proper payroll deductions.  Performs on-line updates on State payroll system (SAP) to start, adjust or refund deductions as needed.  Coordinates billing/refund issues within the department and with Accounting staff, researching applicable reports to verify and process premium refund requests and third-party vendor payments.

Maintains accurate and accessible filing system for non-imaged reports and forms.

Maintains regular and reliable attendance.

Maintains strict confidentiality.

Perform special projects and other related duties as needed.

Required Experience

MINIMUM QUALIFICATIONS

 

Enrollment Specialist I

Graduation from high school, and one (1) year of experience performing a variety of clerical duties related to the processing of enrollments, employment status, changes and premium collections of group insurance members, or an equivalent combination of education and experience.

 

Specific experience within the insurance industry enrollment and claims processing is preferred.

 

Enrollment Specialist II

High School diploma or equivalent, and two (2) years experience within the insurance industry performing a variety of clerical duties related to processing of enrollments, employment status, changes and premium collections of group insurance members, or an equivalent combination of education and experience.

 

Six (6) months experience with PEHP is preferred.

 

Specific experience within the insurance industry enrollment and claims processing is preferred.

 

 

Knowledge, Skills, and Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position:

 

Required technical skills include the working knowledge and ability of:

• Various office management systems related to alpha and numeric record keeping.
• Ten-key operation.
• Microsoft Office Suite skills.

 

Required mathematical skills include working knowledge of:

• Ability to calculate figures and amounts such as discounts, percentages, fractions, and ratios.

 

Required basic knowledge of:

• Enrollment programs and processes.
• Federal laws governing HIPAA, COBRA and Family Medical Leave.
• Rules governing Coordination of Benefits and Leave Without Pay.
• Plan and policy set-up processes and procedures.
• ACA reporting processes and procedures.

 

Must possess excellent communication skills:

• Ability to read, analyze, and interpret general business periodicals, technical procedures, or regulations.
• Interpersonal communication skills and public relation skills.
• Proper telephone etiquette.
• Customer service techniques.

 

Must have the ability to:

• Follow written and verbal instructions.
• Prioritize work.
• Establish and maintain effective working relationships with supervisors, managers, coworkers, and the public.
• Perform within deadlines.
• Work well in a team environment as well as independently.
• Multi-task by handling a variety of duties in a timely and efficient manner.
• Follow through with assignments.
• Deal effectively with stress caused by workload and time deadlines.

 

The incumbent must always demonstrate judgment, high integrity, and personal values consistent with the values of URS.

 

Work Environment

Incumbent performs in a typical office setting with appropriate climate controls.  Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing and seeing.  Common eye, hand, finger dexterity required to perform essential functions.