Heavy contact with providers, participants, their families and business managers. Contact with the Department management, Health Department, Eligibility Department, Pension Department and Contributions Department personnel. Daily contact with vendors (medical, prescription, dental and vision, etc.).

ESSENTIAL FUNCTIONS

Provide benefits information to providers, participants and their business managers for medical, dental and vision claims.
Handle all issues regarding the Health Plans prescription vendor; verifies benefit coverage, vacation overrides, medication authorizations by contacting client services department and by on-line updates. Also contacts various pharmacies and helps pharmacists through the authorization process.
Handle all questions regarding the Health Plans Dental and Vision benefits.
Assist the participants and providers with their calls regarding claims payment issues by researching the system, faxing or reissuing claims documentation. Work with claims examiners regarding any adjustments or questions about a claim that were discussed with the caller.
As applicable, follow up with callers to explain the resolution of the issue they originally reached out to the Health Plan about.
Review the Health Plan Summary Plan Description, medical reference books and guidelines to determine coverage of claims under the Health Plan.
Regular, predictable, and reliable attendance is required.
Ability to accept direction and developmental guidance from supervisor.
Ability to work effectively with individuals at all levels.

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