Description

The primary function of this position is to handle the eligibility of all participants in the MCBOCC’s health, pharmaceutical, life, dental, and vision plans (enrollment, dependent coverage, terminations, and retirement).

Requirements

ESSENTIAL JOB FUNCTIONS

• Determines eligibility of all enrollees based on applicable standards, including employees, dependents, retirees, COBRA participants, etc.
• Processes all new group insurance enrollees.
• Processes all coverage changes: open enrollment, life events, qualified medical child support orders, etc.
• Maintains eligibility with Third-Party Administrators (TPA), Pharmacy Benefit Managers (PBM), and dental and vision carriers, requiring data entry in systems.
• Updates internal database with all changes relevant to this position’s duties.
• Notifies payroll offices of any insurance premium deductions that are to be started, stopped, or changed for any reason.
• Produces and manages payroll deduction memos (start/stop/change/imputed income/open enrollment/ wellness time off deposit/special enrollment) for medical/prescription, dental, vision and supplemental life coverage to Board of County Commissioners, Sheriff’s Office, Land Authority, Property Appraiser, Supervisor of Elections, Clerk of the Court, Tax Collector and Florida Retirement system payroll offices.
• Coordinates and promotes wellness activities with the Administrator and the Coordinator. 
• Produces or processes all COBRA documentation: elections, initial notifications, terminations, and disability.
• Certifies all backup to invoices (with the exception of claims), related to the Group Insurance office, for sufficiency of Finance Department standards. 
• Prepares and ensures all necessary backup acquired per contracts and routes for signature all Employee Benefits invoices; ensures timely distribution of payments to approximately 16 vendors to avoid contract or policy cancellations or interruptions in vendor services. 
• Maintains data and tracks utilization of in-network providers vs out-of-network providers, inpatient hospital length of stay, emergency room visits, urgent care visits, professional services, and Teladoc utilization.
• Maintains all invoice records on the County’s fiscal calendar.
• Investigates and attempts resolution for detailed claim issues.
• Prepares premium refund requests for enrollees.
• Produces initial notification (regarding insurance benefits) of employee leave designations.  
• Assists Administrator with follow-up on leave designations.
• Assists the Administrator in ensuring completion of questionnaires for the Federal government’s Data Match project and other reports as needed.
• Processes life insurance claims.
• Orients new employees on health insurance benefits.
• Monitors employee FMLA leave designations for insurance eligibility purposes. 
• Researches and prepares special projects as deemed necessary.
• Serves as backup to the Administrator on duties relating to group insurance.  
• Assists with phone calls and walk-ins.
• Responsible for personally knowing and following the County’s Personnel Policies and Procedures, Administrative Instructions, Department Operating Procedures, and applicable Statutes and Regulations.  Responsible for ensuring others also adhere to these standards.
• Performs other related job duties as assigned.
• In the event of special, emergency, or disaster situations, employee may be required to work schedules other than those for which they are regularly scheduled in any capacity deemed appropriate.

QUALIFICATIONS

Education and Experience: High School Diploma or GED. 3 years minimum of prior related work experience.

Special Qualifications: None.

Knowledge, Skills, and Abilities: 

• Ability to work from a general outline of duties and responsibilities; Other employees assist in completing work.
• Ability to perform entry-level professional work, including basic data analysis and synthesis, report creation, process performance, and regulatory or compliance activities; knowledge of statistics, operations analysis, and forecasting.
• Ability to work in a responsive environment where co-workers or citizens bring problems for resolution. 
• Ability to determine problems and create an individual solution for the issue.
• Ability to work with less than ten co-workers who are mostly engaged in the same activities.

PHYSICAL DEMANDS

The work is light and requires exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force to move objects. Additionally, the following physical abilities are required: 

• Balancing: Maintaining body equilibrium to prevent falling while walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. The amount of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
• Crouching: Bending the body downward and forward by bending leg and spine.
• Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
• Grasping: Applying pressure to an object with the fingers and palm.
• Handling: Picking, holding, or otherwise working, primarily with the whole hand.
• Hearing: Perceiving the nature of sounds at normal speaking levels with or without correction. Ability to receive detailed information through oral communication, and to make the discrimination in sound.
• Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. Occurs to a considerable degree and requires substantial use of upper extremities and back muscles. 
• Manual Dexterity: Picking, pinching, typing, or otherwise working, primarily with fingers rather than with the whole hand as in handling.
• Mental Acuity: Ability to make rational decisions through sound logic and deductive processes.
• Pulling: Using upper extremities to exert force in order to draw, haul, or tug objects in a sustained motion.
• Pushing: Using upper extremities to press against something with steady force in order to thrust forward, downward, or outward.
• Reaching: Extending hand(s) and arm(s) in any direction.
• Repetitive Motion: Substantial movements (motions) of the wrist, hands, and/or fingers.
• Speaking: Expressing or exchanging ideas by means of the spoken word, including the ability to convey detailed or important spoken instructions to other workers accurately and concisely.
• Standing: Particularly for sustained periods of time.
• Stooping: Bending body downward and forward by bending spine at the waist. Occurs to a considerable degree and requires full motion of the lower extremities and back muscles.
• Talking: Expressing or exchanging ideas by means of the spoken word, including those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
• Visual Acuity: Have close visual acuity to perform an activity such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; and/or extensive reading.
• Walking: Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another.

WORK ENVIRONMENT

Work is performed in a dynamic environment that requires sensitivity and responsiveness to changes that include goals, priorities, and needs of the organization and position.