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EMPLOYEE BENEFITS CLAIMS CLERK
DISTINGUISHING FEATURES OF THE CLASS
The work involves responsibility for determining eligibility for the various employee benefit programs and the clerical processing and data entry for health, dental, and other employee benefits. The employee is also responsible for explaining and interpreting benefit coverage and claims processing procedures to employees and retirees. An employee in this class works within the guidelines of the various mandates that govern benefit programs. Supervision of subordinate employees is not a function of this class. Does related work as required.
TYPICAL WORK ACTIVITIES
Determines eligibility for employee health, dental, prescription drug, vision, and long term disability programs.
Determines eligibility and subsequent enrollment in the various leave programs offered by the employer.
Performs data entry of enrollment information changes.
Prepares departmental and individual billings for reimbursement of benefit costs.
Communicates with the plan administrator on all changes of enrollment application.
Responds to telephone and written inquires from providers, employees, and plan administrators on eligibility criteria, benefit provisions, and claims handling and procedures.
Maintains information on retirees and retirement programs and communicates such benefits to these members.
Meets with groups of employees to advise them on various benefit programs and procedures.
Processes terminations for employees. Determines and advises of COBRA rights and enrolls members into the program under COBRA continuation.
Determines whether a claimant is eligible for benefits in accordance with rules and regulations of the programs.
Maintains records and enrollment into the flexible spending program.
Certifies student enrollments for continued eligibility in the benefit programs.
Interprets and complies with various union agreements as they pertain to the benefit programs.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS
Good knowledge of rules, regulations and eligibility criteria of the employee benefits programs.
Good knowledge of employee benefits terminology and procedures involved in processing benefit claims.
Good knowledge of the various federal, state, and local laws and mandates as they pertain to the employee benefit programs.
Good customer service skills and the ability to give information and relate well with people in person and over the telephone regarding benefit matters.
Good computer skills in order to maintain data necessary for the overall performance of benefit programs.
Ability to interpret written, narrative, and tabular material regarding benefit programs.
Three (3) years of work experience, or its part-time equivalent, in verifying
and processing insurance claims, or in reviewing and processing other benefit program eligibility criteria.
05/2009 Date Revised