Benefits Eligibility Specialist (MAS3/ERB)

Benefits Eligibility Specialist (MAS3/ERB) 

This recruitment will be used to fill multiple positions.

Join our team as a Benefits Eligibility Specialist (Medical Assistance Specialist 3/MAS3) in the Employees and Retirees Benefits (ERB) Division. Support the PEBB and SEBB Programs by providing guidance on eligibility, insurance benefits, and enrollment through phone, email, and in-person interactions. Utilize a multi-line phone system, Benefits 24/7, and other tools to assist customers. We're looking for someone with excellent communication, time management, and problem-solving skills, who can thrive in a fast-paced environment. Apply today and improve health care services for Washington residents!

All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

About the division:

The Washington State Health Care Authority (HCA), the state’s largest healthcare purchaser and behavioral health authority, ensures residents have access to essential health services. Within HCA, the Employees and Retirees Benefits (ERB) Division manages a $5 billion budget to support over 725,000 individuals through two main programs. The Public Employees Benefits Board (PEBB) Program provides insurance and benefits to employees of state agencies, higher education institutions, and their dependents, including retirees and those eligible for COBRA. The School Employees Benefits Board (SEBB) Program offers coverage for employees of K-12 schools, Educational Service Districts, Charter Schools, and their dependents, also providing COBRA continuation. Both programs aim to improve health outcomes, care quality, and cost efficiency through value-based purchasing and policies aligned with the Triple Aim framework.

About the position: 

The Benefits Eligibility Specialist (Medical Assistance Specialist 3/MAS3) role is part of the Customer Service Unit in the Benefits Accounts Section of the Employees and Retirees Benefits (ERB) Division. Reporting to the Medical Assistance Specialist 5 (MAS5) supervisor, this position supports the HCA mission and the Governor's healthcare priorities by ensuring high-quality customer service to subscribers and dependents of the PEBB and SEBB Programs, including retirees, COBRA/continuation coverage recipients, and K-12 members. The role also involves administering customer service via a multi-line telephone system.

This position is eligible to telework part-time and is required to report on-site 1-2 days a week to meet business need. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis.

Some of what you will do:

• Utilize a multi-line telephone and a toll-free line to administer customer service.
• Use excellent communication skills and effectively communicate with customers and peers, utilizing a high degree of verbal and listening skills.
• Counsel customers and members on PEBB and SEBB Programs’ eligibility, policies, procedures, insurance benefits, rights and responsibilities, access to services, and enrollment status via phone, lobby, email, and HCA Support.
• Assist customers in managing and navigating their electronic profiles and benefits elections in Benefits 24/7.
• Utilize various database systems and software programs, which include but are not limited to: HRISD/PAY1, Benefits 24/7, DRS Secure Client Remote Terminal (CRT), Avaya, Microsoft Office, Service Now, and AX20 imaging system, in the performance of all duties.
• Assist customers in web-based application navigation to elect benefits and manage profiles.
• Troubleshoot log-in issues and direct customers with accessing their Benefits 24/7 account through Secure Access Washington (SAW).
• Independently analyze and process applications and documents for health benefits eligibility and enrollment, including reviewing various enrollment forms, Medicare cards, dependent verification, tobacco and spousal premium surcharges, wellness incentives, etc., in addition to other work such as ad hoc reports and projects as assigned by the ERB Division Customer Service Medical Assistance Specialist 5 (MAS5) supervisor or Customer Service Operations manager based on business needs.
• Participate in committee and project teams as requested. Some examples include participating in process improvement feedback and activities, employee resource groups, team meetings, or HCA materials reviews.
• Attend and complete training courses as directed by the agency or supervisor by the required deadlines.
• Attend and participate in staff meetings.

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

Option 1: 

Bachelor’s degree and one (1) year of the experience as defined below

Option 2:

Associate degree and three (3) years of the experience as defined below

Option 3: 

Five (5) years of the experience as defined below

Option 4:

One year as a Medical Assistance Specialist 2.

The required experience includes one or a combination of the following: 

• Provide direct client services or counsel customers in the areas of health insurance, disability, or other related health benefits.
• Determine public assistance eligibility.
• Process, adjust, and investigate health insurance premiums/claims.
• Handle other medical premiums/claims/eligibility-related tasks.
• Research and analyze complex rules, regulations, or policies.
• Utilize research and analysis to make determinations, solve problems, or complete work while providing direct customer service either in person or on the telephone.

Preferred qualifications:

• Ability and willingness to work in a high-pressure, customer contact center/production environment.
• Understand PEBB and/or SEBB Programs’ information sources, including WACs, policies, and procedures.
• Experience using the Benefits 24/7 system.
• Possess superior communication, customer service, time management, and interpersonal skills.
• Have experience working with computers and database and software programs.
• Ability to navigate several screens, web-based applications, and forms simultaneously.
• Be adept at switching priorities at a moment’s notice and able to complete tasks with multiple deadlines.
• Ability to achieve results and stay calm during stressful circumstances.
• Possess excellent mathematical skills.

Note: Completion of the Certificate of Medical Billing and Coding or related certificate may substitute for up to two years of education.

How to apply: 

Only candidates who reflect the required qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach:

• A cover letter that specifically addresses how you meet the qualifications for this position
• Current resume 

To take advantage of veteran preference, please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter. 
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov. 

About HCA:  

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

 What we have to offer:

• Meaningful work with friendly co-workers who care about those we serve Voices of HCA 
• A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package WA State Government Benefits
• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby. 
• Tuition reimbursement
• And free parking! 

Notes:

This position is covered by the Washington Federation of State Employees (WFSE). Once the listed position(s) is(are) filled, this recruitment announcement may also be used to fill additional position(s) for up to sixty (60) days.

Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Lisa Fleming at (360) 725-1723 or lisa.fleming@hca.wa.gov.

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify® is a registered trademark of the U.S. Department of Homeland Security.

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Salary : $45,732 - $61,406