Job Summary: 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.
Responsibilities:- 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:Experience: 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
Education: High School diploma or equivalent, required. Associate's degree, preferred.
Licenses / Certifications: 
