Job Title: Health Benefits Specialist                                               

Wage/Hour Status: Non-Exempt

Reports to: Director-Benefits & Risk Management                         

Pay Grade: Secretary/Clerical 7

Dept. /School: Benefits & Risk Management                                 

Days:  227

Supervises:

Primary Purpose: 

Provide oversight and coordinate the district’s employee benefits program in such a manner that employees become aware of such programs and are able to access information in order to make decisions related to employee benefits.

Qualifications:

Education/Certification:

• Bachelor’s degree preferred; will consider compensating work experience.

            Special Knowledge Skills:

• Knowledge of employee benefits and health plans;
• Knowledge of medical insurance claims and eligibility/issues;
• Computer competency;
• Skills necessary to multi-task;
• Strong organization and time management skills;
• Strong verbal and written communication skills;
• Basic accounting skills.

Experience:

• Minimum 3 to 5 years’ successful job experience

Major Responsibilities and Duties:

• Accurately maintain all records for ECISD self-funded medical program;
• Welcome and assist District employees with inquiries or changes related to their benefits, directing them to the appropriate team member;
• Assist with requisitions, purchase orders, and travel for Benefits team members;
• Facilitate all aspects of COBRA reporting and premium payments;
• Communicate (prepare, distribute and verify) member’s eligibility changes to TPA and pharmacy administration;
• Reconcile payroll eligibility and deduction reports for ECISD medical plan;
• Report claims for ECISD life, supplemental and dependent life;
• Audit reports (Benefits/Payroll deductions);
• Inform and/or clarify plan document changes to employees, as needed;
• Respond to inquiries and direct caller to proper administrator for filing requirements, claim resolution.
• Process and review monthly “Age Limit” reports from Aetna in the First Financial Portal;
• Maintain an FML list, review daily to process any changes. Review FML list with monthly/semimonthly payroll checks, if an employee does not receive a paycheck.  Send a collections notice, process payments, and process payment, and returning to work re-enrollment.
• Process Verification for National Medical Support (Attorney General-Medical Support Unit);
• Route appeals (along with background information and clarifying data) to director of Risk Management and Benefits;
• Facilitate new employee benefits orientation as needed;
• Inform employees of changes at annual department meeting; recommend claim/enrollment form modifications when necessary;
• Create and publish (on the Benefits Site) the New Hire video presentation for all full-time employees
• Participate in interdivisional training;
• Prepare quarterly report for director identifying large loss and case management claims;
• Process Purchase Orders for all vendors such as Aetna, PCARx, Stop Loss Provider, Centers, Recuro, and all required payments weekly.
• Balance budget accounts on all existing PO’s and prepare for review and signatures from Director;
• Maintain department website by updating constantly changing information on available coverages in medical and pharmacy plans;
• Requisition department supplies and monitor cost and inventory;
• Organize and facilitate funds and requisition for yearly records purge;
• Ensure the integrity of the district and maintain confidentiality of all information;
• Perform other duties as requested by the Director of benefits and Risk Management.

Supervisory Responsibilities:

• N/A

Working Conditions:

Mental Demands/Physical Demands/Environmental Factors:

Maintain emotional control under stress. Very limited districtwide and statewide travel. Occasional prolonged or irregular hours.

The foregoing statements describe the general purpose and responsibilities assigned to this job and are not an exhaustive list of all responsibilities and duties that may be assigned or skills that may be required.  I have read, understand and attest to the above description and funding relating to my daily activities.

Signature                                                                                              Date                                              

                                                                                                                                               02/2025

Salary : $163 - $227