Health Insurance Benefits Manager

 

CTPF

Job Description

 

 

Job Title:                    Health Insurance Benefits Manager

Department:              Benefits                                                                                                               

 

 

SUMMARY Provides year round data analysis and on-going contract negotiations with health insurance vendors for open enrollment, analyzes CTPF benefit plans, manages health insurance team with enrollment of members into health insurance plans and processing of health insurance rebates.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

 

Serves as filter and buffer of all things HealthCare to the Executive Director.

 

Educates Executive Director on all things HealthCare, to the point that he can support and articulate goals with Trustees.

 

Ongoing cost analysis on all plans to understand status, trend and areas of opportunity that will reduce spending.

 

Ongoing in-depth review of benefit plan designs to understand performance, proven outcomes or failures and utilization to support the need for change.

 

Expect and demand strategic partnership and creative thought from all vendors.

 

Review all contracts to identify gaps (paying too much for too little) and renewal strategies.

 

Build a health benefit appropriate for the demographic.

 

Become HIPAA compliant.

 

Manage RDS (Drug subsidy from Medicare via our providers) which includes the following:

-Audit eligibility to ensure we are reporting the right people

-Annual reconciliation of our providers

-Figure out if CTPF should move to other methods of subsidy

 

Conduct an organizational review of the health benefit team, such as areas for improvement in terms of process and performance, build job descriptions and performance plans.

 

Continue to refine a communication strategy for annual enrollment and new retirements.

 

Develop an SPD (summary plan document).

 

Review eligibility rules.

 

Rebuild enrollment data warehouse.

 

Create and automate eligibility data transmissions with vendors.

 

Determine feasibility of self insurance.

 

Provide telephone support to the Member Services Unit for health insurance questions.

 

SUPERVISORY RESPONSIBILITIES

Manages 3 staff members:

Rebate and Insurance Administrator

Insurance Counselor/Specialist

Intern

 

 

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

EDUCATION and/or EXPERIENCE

Bachelor's degree (B. A.) from four-year college or university in business; 5 years related experience and/or training; or equivalent combination of education and experience in supervision/management, benefit or public pension plans, and customer service.

 

 

SKILLS

Excellent written and communication skills

Excellent organizational skills

Microsoft Word

EXCEL