Under general supervision, this position is responsible for the daily administration of health and welfare, retirement and other benefit plans at WMCHealth. Responsibilities require extensive contact with insurance carriers, employees, retirees, and benefit plan administrators, as well as the input and maintenance of accurate benefits data in the HRIS database and external administrators' eligibility systems. Does related work as required.
* Maintains and processes benefit enrollments, changes and terminations for all plans, including medical, dental, prescription drugs, vision, flexible spending accounts, COBRA and retirement.* Maintains and updates eligibility database and ensures proper enrollment of employees based upon eligibility guidelines, terminations and changes as required.* Provides explanations of benefit programs to employees as well as departmental representatives to facilitate administration of these programs.* Responds to employee complaints or problems and reviews and researches claim issues for participants.* Gathers and compiles data and create reports as needed with HRIS database and Excel spreadsheets.* Communicates with representatives from insurance companies to discuss benefits and claim issues.* Audits and reconciles benefit plan invoices and eligibility files and processes monthly invoices for payment.* Contacts, both in writing and by telephone, insurance carriers, employees and eligible former employees to ensure implementation of, and compliance with, program requirements as well as for resolution of unusual problems.* Provides necessary data concerning enrollments, terminations, leaves without pay, and Medicare reimbursement claims as required.* Analyzes and interprets new or revised requirements or programs for the purpose of determining their impact upon existing administrative and procedural activities.* Assists in coordination of annual enrollment for plan participants ensuring all changes are processed correctly.Qualifications/Requirements:
Five years of relevant experience performing employee benefits functions and assisting in the administration of health insurance plans, which included responsibility for identifying problems, obtaining and analyzing relevant information, and determining solutions
Good knowledge of various health insurance and retirement programs, including benefit limits, eligibility criteria, and administrative and procedural requirements; good knowledge of governmental, provider and hospital rules, regulations, agreements and procedures that affect benefit programs; good knowledge of basic medical and insurance industry terminology; knowledge of third party and medical provider billing and payment procedures; knowledge of Medicare procedures and benefits; ability to evaluate and analyze potential program problem areas and to formulate and recommend workable solutions; ability to communicate effectively both orally and in writing; ability to gather and organize pertinent data and to draw appropriate conclusions; ability to establish and maintain effective working relationships; ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position; ability to use computer applications such as spreadsheets, word processing, e-mail and database software; tact; good judgment; integrity; resourcefulness; physical condition commensurate with the demands of the position.
WMCHealth is a 1,900-bed healthcare system headquartered in Valhalla, New York, with ten hospitals on eight campuses spanning 6,200 square miles of the Hudson Valley. WMCHealth employs more than 12,000 people and has nearly 3,000 attending physicians. From Level 1, Level 2 and Pediatric Trauma Centers, the region’s only acute care children’s hospital, an academic medical center, several community hospitals, dozens of specialized institutes and centers, a state of the art Telemedicine program, skilled nursing, assisted living facilities, homecare services and one of the largest mental health systems in New York State, today WMCHealth is the pre-eminent provider of integrated healthcare in the Hudson Valley.