Utah Retirement Systems

  • Enrollment Specialist II

    Location US-UT-Salt Lake City
    Posted Date 4 days ago(7/12/2018 10:22 AM)
    Job ID
    USD $15.16/Hr.
    USD $18.95/Hr.
  • About The Company

    A division of Utah Retirement Systems, PEHP is a non-profit trust with the vital job of providing health benefits to Utah’s public employees and their families.

    Job Description


    Performs a variety of higher level clerical duties as needed to expedite the day to day processing of enrollments, employment status, changes and premium collections of group insurance members and individual Medicare policies.



      1. Processes member enrollment and change forms, including data entry into PEHP system, verifying proper completion of enrollment and change documentation. Requests and verifies information as needed to expedite enrollment. Audits daily online enrollment activity and periodic electronic enrollment activity.
      2. Follows up with employer groups, third party vendors, brokers and members to complete enrollment and change process. Processes and monitors actions related to COBRA, Leave, LTD, and COBRA benefits ensuring compliance with HIPAA, COBRA, FMLA, Leave without Pay, ACA, and IRS regulations, and to maintain correct status of Subscribers and Dependents based on age, dual COB order and other eligibility requirements. Accesses imaged documents for historical verification in order to respond to employer groups, broker or for members.
      3. Interviews and counsels walk-in members regarding eligibility in PEHP retiree health plans, employer paid health benefits, and Medicare related questions. Assists in completion of application forms. Initiates related premium billing or deduction plans. Verifies that retiree enrollment information is authorized by the employer group. Educates current and prospective retirees on the benefits of PEHP Medicare and Medigap plans, coordination of benefits, and premium billing process. Makes outbound calls to potential Medicare Supplement members to inform them of PEHP’s products and signs them up for Medicare Supplment plans.
      4. Provides telephone technical support for members using the PEHP online enrollment system. Provides telephone and reporting support to other internal departments, employer group HR/benefit coordinators, and brokers regarding eligibility information, plan availability, PEHP Master Policy rules, limits, HSA/FLEX eligibility/rules, claim payment, and discrepancies with enrollment
      5. Performs comprehensive monitoring of benefit payments (eligibility, premiums, billing) to assure proper credit to employer groups and members. Monitors payroll deduction reports to ensure proper payroll deductions. Performs on-line updates on State payroll system (SAP) to start , adjust or refund deductions as needed. Coordinates billing/refund issues within the department and with Accounting staff, researching applicable reports to verify and process premium refund requests and third party vendor payments.
      6. Performs complex and technical aspects of enrollment and maintenance of special programs such as early retirements and Medicare supplement plans. Processes periodic EDI/flat enrollment/change files from brokers and employees, ensuring transactions are valid and complete. Researches and processes monthly reports to verify active employment terminations, transitions to Medicare, or other status changes. Mails letters and appropriate enrollment forms to prospective and current retirees, notifying them of premium changes, plan termination, or status change. Processes ACA employer group files, requests and verifies information as needed to process files. speaks to employer groups regarding files.
      7. Responds to ORS dependent orders, verifying or adding dependents. Provides certificates of coverage, COBRA information, rates and other documents as requested by members.
      8. Maintains enrollment process documentation for department use, reference and training. Maintains accurate and accessible filing system for non-imaged reports and forms.
      9. Maintains strict confidentiality.
      10. Perform special projects and other related duties as needed.

    Required Experience

    Education and Experience

    High School diploma or equivalent and two (2) years experience within the insurance industry performing a variety of clerical duties related to processing of enrollments, employment status, changes and premium collections of group insurance members; OR an equivalent combination of education and experience.


    Six (6) months experience with PEHP is preferred.


    Specific experience within the insurance industry enrollment and claims processing is preferred.



    Knowledge, Skills, and Abilities

    Working knowledge of purposes, principles and practices of public insurance systems; insurance laws, IRS filing requirements regarding ACA, codes, policies and guidelines related to various insurance and benefit programs; computer operations and technical software applications; general office practices and procedures; alpha and numeric recording systems; basic public relations; telephone etiquette; bookkeeping and related statistical procedures.


    Ability to communicate regarding a variety of insurance issues and programs. Communicate effectively verbally and in writing; ability to follow written and verbal instructions; establish and maintain effective working relationships with supervisors, managers, co workers and the public; perform basic mathematical calculations; operate a variety of types of office equipment including computer terminal, calculators, etc.; work independently and deal effectively with stress caused by work load and time deadlines.


    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. 


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