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.

For most jobs, remote work is available for 9 out of every 10 workdays.

POSITION SUMMARY

This position plays a critical role in PEHP’s efforts to serve and create value for our members by helping them understand their benefits, resolve problems, and assisting with requests for benefit eligibility. Performs a variety of administrative duties and data entry for compiling disability claim files, obtaining medical records, and tracking premium payments. Responsible for various administrative tasks, data entry, and reviews related to third party liability and overpayment recovery. This position requires strong organizational skills and the ability to manage diverse tasks in a supportive role. Successful performance for this position requires a genuine interest in helping others, a high level of commitment, attention to detail, and the ability to learn about and share complex information. 

ESSENTIAL DUTIES & RESPONSIBILITIES

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 mails notifications.
3. Processes mail, data entry, receives phone inquiries, answers general questions, maintains claim diaries of tasks, provides administrative and clerical support and prepares routine and specialized correspondence.
4. Assists Disability Specialists with monthly payroll audit, claims updates, and annual W-2 process.
5. Maintains pending disability applications to include creating electronic files, notifies and obtains information from employers and URS, requests medical records, and pays record invoice.
6. Maintains electronic files in Laserfiche and quality checks imaging process.
7. Prepares files and documentation for medical consultant reviews, vocational reviews, and clinical visits.
8. Compiles data spreadsheets for pending claims and file reviews.
9. Compiles data spreadsheets for outside collection vendor for placement of member and provider overpayments.
10. Runs departmental monthly reports and completes required tasks.
11. Reviews existing refund requests for medical/dental claims for receipt.
12. Processes refund requests for medical/dental overpayments.
13. Processes deductions for PEHP medical and dental.
14. Places holds on member claims related to third party liability, creates documentation and correspondence and performs follow-up tasks through phone calls, email and/or letters.
15. Performs other related duties as required.
16. Maintains regular and reliable attendance.
17. Maintains strict confidentiality.

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/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.
• Computer operations and technical software applications.
• Microsoft Office Suite.
• 10 key calculators.
• Type 40 wpm.

Required mathematical skills include working knowledge of:

• Intermediate math skills in calculating figures and amounts such as discounts, interest, proportions, and percentages.
• Employer premium percentages and accuracy.
• Statistical analysis for trending.
• COLA calculations.
• Basic bookkeeping.

Must possess excellent communication skills:

• Read, analyze, and interpret general business periodicals, technical procedures, and regulations.
• Write reports, business correspondence, and procedure manuals.
• Create presentations and documentation for LTD Manager. Occasional presentations to internal departments.
• Present complex 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.

Required working knowledge of:

• Insurance principles.
• Medical, dental, pharmacy, and Medicare supplement claim adjudication policies, procedures, and processes.
• Policy and COB provisions and regulations.
• CPT and ICD-10 coding.

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.
• Quality control peer math calculations.
• Perform within deadlines.
• Work well in a team environment as well as independently.
• Establish and maintain effective working relationships with professionals, executives, department heads, coworkers, 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.