Utah Retirement Systems

LTD/Recoveries Administrative Assistant

UT-Salt Lake City
6 days ago
Job ID
2017-2476
Category
Long Term Disability (LTD)
Min
USD $14.86/Hr.
Max
USD $18.58/Hr.

About The Company

Utah Retirement Systems (URS) provides benefits for state and other Utah public employees.  It has two divisions.  The Retirement Office administers pension and retirement savings plans.  PEHP specializes in medical, dental, life, and other benefits.

Job Description

POSITION SUMMARY

Performs a variety of clerical, technical, and administrative duties for processing of long-term disability claims (Non-HIPAA Covered Entity), recoveries (HIPAA Covered Entity), third party liability tasks, departmental support file management and premium payments. 

 

ESSENTIAL JOB FUNCTIONS AND DUTIES

  1. Monitors, documents and quality checks premium payments from participating employers. Contacts employers regarding delinquent payments/errors and sends demand letters. Assists with monthly audit process of premium payments.
  2. Maintains and calculates annual review of COLA increases for beneficiaries and mail notifications.  
  3. Maintains data on pending and approved LTD claims.
  4. Prepares routine and specialized correspondence as requested for LTD Department.
  5. Compiles data spreadsheets for outside collection vendor for placement of member and provider overpayments.
  6. Provides administrative and clerical backup as assigned by LTD staff members.
  7. Maintains diary review system on approved LTD and life-only disability claims.
  8. Assists LTD Specialists with monthly payroll audit.
  9. Assists LTD Manager and LTD Specialists with W2 audit process.
  10. Receives and disperses incoming LTD phone calls, answers general questions.
  11. Processes all incoming and outgoing mail. Sorts mail refund requests for medical/dental overpayments.
  12. Maintains pending LTD applications to include creating files, mailing application, notifying employers and URS, requests employer information and medical records.
  13. Reviews complex claims histories and analyzes patterns to determine appropriate medical record requests.
  14. Analyzes medical record billings and authorizes payments.
  15. Maintains filing, and performs general clerical, technical and administrative duties.
  16. Organizes, files, archives files and retrieves archived files as needed.
  17. Prepares files and documentation for scanning. Quality checks scanning process.
  18. Reviews existing refund requests for medical/dental claims for receipt.
  19. Maintains strict confidentiality.
  20. Reviews internal recovery reports including the Coordination of Benefits and Termination reports to identify and request overpayments.
  21. Processes deductions for PEHP programs including Medical, Dental, and Medicare Supplement.
  22. Reviews Third Party Liability report and identifies potential subrogation cases, this will entail sending investigational correspondence, tracking the receipt of the correspondence and analyzes the returned correspondence to identify TPL.
  23. Places holds on member files to prompt response of correspondence to decrease potential liability.
  24. Opens files when subrogation is applicable by documenting information in TPL database for single workers compensation cases and simple TPL cases.
  25. Performs follow-ups on open files.
  26. Performs other related duties as required.

Required Experience

MINIMUM QUALIFICATIONS

Education and Experience

High School diploma and two (2) years of experience performing a variety of clerical, technical, and administrative duties; or an equivalent combination of education and experience.

 

Specific experience in LTD / time-loss insurance claims, advanced knowledge of personal computer operations, and medical and dental terminology is preferred.

 

Knowledge, Skills, and Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position:

 

Required technical skills include the working knowledge and ability of:

  • Various office management systems related to alpha and numeric record keeping and data entry.
  • Personal computer operations (PC/Microsoft Office/Email) and various program applications.
  • Use of 10 key calculator.
  • Type 40 wpm.

 

Required mathematical skills include working knowledge of:

  • Intermediate math skills in calculating figures and amounts such as discounts, interest, commissions, proportions, and percentages. Such as employer premium percentages and accuracy.
  • Statistical analysis for trending.
  • COLA calculations.
  • Quality control of peer math calculations.
  • Basic bookkeeping.

 

Must possess excellent communication skills:

  • Read, analyze, and interpret general business periodicals, technical procedures or regulations.
  • Write reports, business correspondence, and procedure manuals.
  • Create presentations and documentation for LTD Manager. Occasional presentations to internal departments.
  • Present complex and difficult scenarios and consequences to members, peers, managers, health providers, outside adjusters, and other carriers.
  • Interpersonal skills in working with claimants, employers, outside claim adjusters, health providers, internal managers, and co-workers.
  • Business grammar, spelling, letter composition, and telephone etiquette.
  • Routine negotiation and public relation skills.

 

Must possess general insurance skills:

  • Basic knowledge of insurance principles.
  • Considerable knowledge of medical, dental, pharmacy, and Medicare supplement claim adjudication policies, procedures, and processes.
  • Knowledge of the intricacies related policy provisions and CPT and ICD.10 coding, COB provisions and regulations.

 

Must have the ability to:

  • Deal with claimant medical and financial information with sensitivity, confidentiality and discretion.
  • Follow written and verbal instructions.
  • Organize and prioritize work.
  • Perform within deadlines.
  • Work well in a team environment as well as independently.
  • Establish and maintain effective working relationships with professionals, executives, department heads, co workers and the public.
  • Multi-task by handling a variety of duties in a timely and efficient manner.
  • Follow through with assignments.
  • Deal effectively with stress caused by workload and time deadlines.

 

The incumbent must always demonstrate judgment, high integrity, and personal values consistent with the values of URS.

 

 

Work Environment

Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing and seeing. Common eye, hand, finger dexterity required to perform essential functions. 

 

Occasional lifting up to 35 lbs is required. 

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