Insurance/Benefits Accounts Spec
Positions in this job family are assigned responsibilities involving specialized accounting and auditing work related to the maintenance and reconciliation of policy holder premium accounts and member accounts to reflect payments received for various types of insurance and benefits programs administered by a state agency, local government or school. Responsibilities may include reviewing, analyzing, recording and reconciling accounts receivable transactions, posting payments received directly from members, policy holders, and various agency payrolls, responding to inquiries concerning policies and procedures, and advising insurance coordinators, employees and others concerning actions required on various discrepancies, changes or other transactions.
The functions within this job family will vary by level and organization, but may include the following:
- Records accounts receivable transactions and benefit eligibility and creates billing records.
- Reviews and analyzes discrepancy reports and other information concerning payments received for various types of insurance or benefits, such as life, health, vision and dental insurance, workers’ compensation insurance, medical and child care spending accounts and other insurance or benefits programs.
- Determines cause of discrepancies resulting from payments made through electronic transfers or other methods; researches appropriate records or documents as needed to verify payments due and identify any changes in enrollment or status.
- Notifies insurance/benefit coordinators, policy holders, members or others, as needed, concerning actions required to correct discrepancies, adjust accounts or other requirements; provides interpretation of various laws, rules or policies concerning insurance enrollments, benefits allowances, renewal of policies, changes in status and other transactions or entitlements.
- Provides information to employers, employees and others concerning pre-tax and post-tax treatment of employees’ benefits; advises payroll or insurance/benefit coordinators concerning requirements to implement and maintain Internal Revenue Code Section 125 entitlements.
- Posts payroll reports, member accounts and other records to reflect payments received directly from individual policy holders, members, or agencies, as necessary.
- Prepares various reports, worksheets, statements and other documents; initiates action for payment of refunds on canceled or non-renewable policies; reviews and processes claims for reimbursement from medical or child care spending accounts.
- Reviews and processes changes in enrollment, status and other actions; trains insurance/benefit coordinators and others on the proper use of forms and procedures for enrollments and changes and payroll procedures for insurance purposes.
The Insurance/Benefit Accounts Specialist job family consists of four levels which are distinguished based on the level of responsibility assigned, the complexity of work assignments, the expertise required to perform assigned duties and the responsibility assigned for providing leadership to others.
Level I: Code: D51A Salary Band: G
This is the basic level of this job family where employees are assigned responsibilities involving entry level work in a training status to build their skills in maintaining and reconciling policy holder or member accounts related to insurance or benefits programs administered by a state agency. In this role their work will be closely supervised and will include training in the rules, policies and procedures related to the specific area in which responsibilities are assigned.
Knowledge, Skills and Abilities required at this level include knowledge of generally accepted accounting principles; of employee pension laws; of federal COBRA guidelines; of appropriate Internal Revenue Code sections; of auditing principles; of various types of health, dental, disability, life and other insurance programs; and of modern office procedures. Ability is required to review and analyze accounting records and source documents; to establish and maintain computer records; to review financial statements; and to establish and maintain effective working relationships with others.
Education and Experience requirements at this level consist of two years of experience in bookkeeping work, insurance eligibility determination or closely related work; or an equivalent combination of education and experience, substituting the completion of thirty semester hours of college, including six hours of accounting for each year of the required experience.
Level II: Code: D51B Salary Band: H
This is the career level where employees are assigned responsibilities at the full performance level for performing a full range of duties involving the maintenance, analysis and reconciliation of policy holder premium accounts, individual member accounts, and other records related to the billing and receipt of payments for various types of insurance or benefit programs. Responsibilities may also be assigned for providing assistance or training to others in completing required tasks or activities.
Knowledge, Skills and Abilities required at this level include those identified in Level I plus knowledge of laws, rules and policies concerning the insurance or benefits program for which responsibilities are assigned; and of eligibility requirements and procedures for enrollment, changes or other transactions. Ability is required to provide training or assistance to insurance coordinators and others.
Education and Experience requirements at this level consist of those identified in Level I plus one year of experience in the maintenance, analysis and reconciliation of insurance or benefits accounts.
Level III: Code: D51C Salary Band: I
This is the specialist level where employees are assigned responsibilities for performing advanced level duties involving a high degree of freedom and independence in the analysis and reconciliation of various accounts or other records; or in reviewing and processing various actions involving enrollments or changes in insurance or benefits programs, or other activities involving greater responsibility or accountability than is normally associated with positions at the career level.
Knowledge, Skills and Abilities required at this level include those identified in Level II plus demonstrated ability to maintain a full range of insurance or benefits accounts and to perform highly independent work.
Education and Experience requirements at this level consist of those identified in Level II plus two additional years of experience in the maintenance and reconciliation of insurance or benefits accounts.
Level IV: Code: D51D Salary Band: J
This is the leadership level of this job family where employees are assigned responsibility for the supervision of others. This includes assigning and reviewing the work of others, providing training and assistance in the completion of assigned tasks and insuring the completion of required activities. It may also include direct supervision responsibilities involving employee development, approval of leave, disciplinary actions, evaluation of performance and various administrative responsibilities.
Knowledge, Skills and Abilities required at this level include those identified in Level III plus knowledge of supervisory principles and practices. Ability is required to supervise the work of others.
Education and Experience requirements at this level consist of those identified in Level III.