PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utah’s public employees through high quality and competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. As a government entity, we embrace both a public mission and a commitment to creating customer value, excelling in the market, and improving healthcare. We offer a competitive salary with generous benefits, personal development in a positive team environment, and excellent work-life balance.
We are actively recruiting for this position. Interviews will be conducted virtually.
Plays a critical role in PEHP’s efforts to serve and create value for our members by helping them understand their benefits, avoid payment surprises, navigate healthcare complexity, resolve problems, and make good benefit decisions. Performs a variety of duties to handle incoming calls, faxes and emails regarding claims, eligibility, verification of benefits, limitation and exclusions and website related questions, for all PEHP plans. Documents all communications. Successful performance for the position requires a genuine interest in helping others, the ability to learn about and share complex information about health benefits, and a high level of commitment and dependability.
ESSENTIAL DUTIES & RESPONSIBILITIES
Coordination of Benefits Responsibilities
Education and Experience
High School Diploma and one (1) year of progressively responsible experience performing a variety of duties relating to customer service; OR an equivalent combination of education and experience.
Specific experience in health insurance call centers, customer service, or claims adjudication, preferred.
Knowledge, Skills, and Abilities
Requires considerable knowledge of claims adjudication policies, procedures and processes; intricacies related to medical, dental, pharmacy, mental health, home health, chiropractic claims, and Medicare Supplement claims; medical terminology; various office management systems related to alpha and numeric record keeping; interpersonal communication skills; public relations skills; telephone etiquette; personal computer operations (PC/MS) and various program applications; basic bookkeeping; negotiation techniques; some knowledge of 10 key operation; basic mathematics.
Must have the ability to analyze a variety of claims management issues and problems and make corrections; communicate effectively verbally and in writing; ability to follow written and verbal instructions; establish and maintain effective working relationships with professionals, executives (public and private) department heads, co workers and the public; work independently and deal effectively with stress caused by heavy workload and handling difficult or irate phone calls. Must be able to document calls in computer accurately and succinctly. Must be able to interpret medical and other words related to claims, prior authorizations and appeals.
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.