Benefits Analyst - San Francisco Health Service System (1210) - (151744)

Job Description

Under general supervision, performs professional benefits work for the Health Service System's Membership and Medical Claims Divisions and performs related duties as required. Explains the City's health, dental, vision, prescription, disability plans, Flexible Spending Accounts, and Dependent Day Care and Medical Reimbursement programs. Essential functions include: providing written and oral benefits information; advising and counseling members, retirees, and surviving spouses or domestic partners on available benefits; analyzing and resolving member claim problems; processing complex claims; initiating, compiling, calculating, and processing adjustments and manual payments; interacting frequently with staff and providing training as needed; consulting with plan providers and department representatives; researching, reconciling, and resolving employee benefits and claims issues; and conducting workshops and giving presentations.

May exercise technical and functional supervision over technical/clerical staff.

Typical tasks include:

1. Provides written and oral information to members, retirees, medical providers and other interested parties regarding active and retired employee health and welfare benefit programs.

2. Advises and counsels members, retirees, and surviving spouses or domestic partners on available benefits, pursuant to rules and regulations of the Health Service System and federal and state laws.

3. Analyzes and resolves member claim problems.

4. Processes complex claims, and disburses benefits for the Health Service System.

5. Initiates, compiles, calculates, and processes adjustments to member records, premium receivables and medical claim histories.

6. Researches, reconciles, and resolves various member problems related to membership, eligibility, premiums, and medical claims accounts.

7. Interacts frequently and provides training when necessary to subordinate staff engaged in membership enrollments, terminations, accounts receivable, collection, and medical claims adjudication.

8. Consults with plan providers and department representatives regarding the member's status.

9. Conducts workshops for potential retirees and new hires regarding benefits, plans, costs, etc. and assist with the completion of required paperwork. Gives presentations to departmental orientations.

10. Processes and collects manual payments from employees on leave of absence, under COBRA and retirees.

11. Perform word processing and data entry/retrieval/

12. Perform work in a standard office environment.

13. Performs related duties and responsibilities as assigned.