Enrollment Specialist I or II

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.

About the role

This position may be filled at either the Enrollment Specialist I or Enrollment Specialist II level.

Enrollment Specialist I: $16.83/hr – $21.05/hr
Enrollment Specialist II: $19.73/hr – $24.67/hr

Performs a variety of clerical duties to expedite the day-to-day processing of enrollments, employment status changes, and premium collections of group insurance members.

Responsibilities

• 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.
• Follows up with employer groups, third-party vendors, brokers, and members to complete enrollment and change process.
• Processes and monitors COBRA, Leave, LTD, and COBRA benefits ensuring compliance with HIPAA, COBRA, FMLA, Leave without Pay status, 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, brokers, or members.
• Responds to ORS dependent orders, verifying or adding dependents.
• Provides certificates of coverage, COBRA information, rates, and other documents as requested by members.
• 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.
• 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 online 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.
• Maintains accurate and accessible filing system for non-imaged reports and forms.
• Maintains regular and reliable attendance.
• Maintains strict confidentiality.
• Performs special projects and other related duties as needed.

Requirements

• Enrollment Specialist I: Graduation from high school, and one (1) year of experience performing a variety of clerical duties related to the processing of enrollments, employment status, changes, and premium collections of group insurance members, or an equivalent combination of education and experience. Specific experience within the insurance industry enrollment and claims processing is preferred.
• Enrollment Specialist II: High School diploma or equivalent, and two (2) years of 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 of experience with PEHP is preferred. Specific experience within the insurance industry enrollment and claims processing is preferred.

Skills

• Working knowledge of office management systems related to alpha and numeric record keeping.
• Ten-key operation proficiency.
• Microsoft Office Suite skills.
• Ability to calculate figures and amounts such as discounts, percentages, fractions, and ratios.
• Basic knowledge of enrollment programs and processes, federal laws governing HIPAA, COBRA, and Family Medical Leave, rules governing Coordination of Benefits and Leave Without Pay, plan and policy set-up processes, and ACA reporting processes.
• Excellent communication skills, including the ability to read, analyze, and interpret general business periodicals, technical procedures, or regulations.
• Strong interpersonal communication and public relation skills, including proper telephone etiquette and customer service techniques.
• Ability to follow written and verbal instructions, prioritize work, and meet deadlines.
• Ability to establish and maintain effective working relationships with supervisors, managers, coworkers, and the public.
• Ability to work well in a team environment as well as independently, multi-task, and handle a variety of duties in a timely and efficient manner.
• Ability to follow through with assignments and deal effectively with stress caused by workload and time deadlines.
• High integrity and personal values consistent with the values of URS.

Benefits

• Competitive salary with generous benefits.
• Personal development in a positive team environment.
• Excellent work-life balance.
• Remote work available for 9 out of every 10 workdays.

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 may include walking, standing, stooping, sitting, reaching, talking, hearing, and seeing. Common eye, hand, and finger dexterity is required to perform essential functions.