Insurance Benefits Specialist III

Job Posting Title

Insurance Benefits Specialist III

Agency

340 OKLAHOMA STATE DEPARTMENT OF HEALTH

Supervisory Organization

340 HIV/STD Service

Job Posting End Date (Continuous if Blank)

March 26, 2024

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time

Full time

Job Type

Regular

Compensation

The annual salary is up to $53,847.00 based on education and experience.

Job Description

Basic Purpose

Location: Central Office

• 123 Robert S Kerr, Oklahoma City, OK

Salary: Up to $53,847.00 based on education and experience

Full Time /Part Time: Full Time

Work Schedule: Monday-Friday

Primary Hours: 8:00 am

• 5:00 pm

Why you'll love it here!

RESPECT. COLLABORATION. SERVICE. The Oklahoma State Department of Health (OSDH) is committed to leading Oklahoma to prosperity through health. Our mission is to protect and promote health, prevent disease and injury, and cultivate conditions by which Oklahomans can thrive. Check out why we are passionate about public health and believe it is the career for you!!! What is Public Health?

Oh yeah, did we mention perks? We know that benefits matter and that is why we offer a competitive benefits package for all eligible employees.

• Generous state paid benefit allowance to help cover insurance premiums.

• A wide choice of insurance plans with no pre-existing condition exclusions or limitations.

• Flexible spending accounts for health care expenses and/or dependent care.

• Retirement Savings Plan with a generous match.

• 15 days of vacation and 15 days of sick leave the first year for full time employees.

• 11 paid holidays a year.

• Student Loan repayment options & tuition reimbursement.

• Employee discounts with a variety of companies and venders.

• Longevity Bonus for years of service

Position Description: Insurance Benefits Specialist III will be responsible for the determination of eligibility for Ryan White Part B HIV Drug Assistance Program Services and coordination of prescription co-pay and insurance premium assistance activities for the program.

Duties:

• Review incoming HIV Drug Assistance applications, primarily insurance premium and prescription co-pay assistance submitted by external case managers through the program data system; determine, based on program policy, the action to take on application within 10 working days; reject back for additional information (documenting needed action to determine eligibility), approve or deny application. This includes being able to calculate gross income from the income documentation provided, determining who is considered in the household income, ensuring that what is entered in the application is complete in each section and matches the provided attached documentation.

• Prepare and disseminate written communication to clients, applicants, case managers, and providers, scanning and attaching all pertinent documentation to client record.

• Coordinate referrals and transitions to appropriate pay sources and/or benefits, including Medicare D prescription drug plans and the federal marketplace.

• File with insurance carriers for reinstatement of client's insurance when policies are cancelled due to a variety of reasons.

• Coordinate activities with appropriate entities, including the program's contracted pharmacy and insurance premium contractor, HDAP case managers, the state Medicaid agencies (Healthcare Authority and DHS), Oklahoma Insurance Commission, Social Security, Medicare, insurance companies, employers, and ACA navigators.

• Maintain confidential client records and enrollment data.

• Enter and track client information and data on specified Excel spreadsheets and prepare necessary reports.

• Utilize knowledge of health insurance coverage plans to review health insurance plans for the coverage the plan provides, e.g. prescription coverage and in-network/out-of-network physician status.

• Coordinate, track, and resolve insurance coverage and premium payment issues with the program insurance and pharmacy contractor.

• Other duties as assigned.

Minimum Qualifications:

Level III: Education and Experience requirements at this level consist of a bachelor's degree and four years of experience in the health insurance industry in areas such as benefits analysis, claims review or analysis, or medical/dental review or report preparation; or an equivalent combination of education and experience, substituting one year of qualifying experience for each year of the required degree.

Application Requirements:

• If education, certification or licensure is required to meet qualifications, applicants must provide documentation at the time of application.

• All applicants are subject to a background check and must be legally authorized to work in the United States without visa sponsorship.

Physical Demands and Work Environment: This position is set in an office environment, computer based. While performing the duties of the job, employees are frequently required to stand, walk, lift, and reach.

Telework: This position is eligible for Telework up to 4x/week after 90 days and is subject to OSDH policy and supervisor's discretion.

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.

Current State of Oklahoma employees must apply for open positions through their Workday account. Go to Careers app on WD home screen>Click on 'Find Jobs-Internal State of Oklahoma'.