Client Benefit Analyst - Highmark Health : Job Details

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This job provides account support activities associated with the administration of all experience rated and community rated dental groups.The incumbent is responsible for providing or coordinating prompt support to UCCI Sales and Service personnel, group administrators, brokers, and Agent Plan personnel to ensure the resolution of issues related to benefit interpretations, customer service inquiries, claims adjudication, benefits issues, membership and billing activity, etc. This job is ultimately responsible for ongoing account retention, satisfaction, and administration, complementing the efforts of Sales and Service Executives. This activity is intensified and focused for new accounts.This additionally includes identifying and resolving problems related to benefit interpretations, rating concerns and any subsequent adjudication requirements. To this end, the incumbent cultivates and maintains efficient working relationships with key internal areas, such as Customer Service Operations (Claims, Dental Benefits, Customer Service, Membership & Billing),Provider Data Management, Underwriting, and Professional Relations.

ESSENTIAL RESPONSIBILITIES

• Provide account support activities associated with the administration of all experience rated and community rated dental groups.The Client Benefit Analyst is responsible for providing or coordinating prompt support to UCCI Sales and Service Personnel, group administrators, brokers, and Agent Plan personnel to ensure the resolution of issues related to benefit interpretations, customer service inquiries, claims adjudication, benefits issues, membership and billing activity, etc.
• Collect and analyze customer specific information including gathering data from multiple sources related to Benefit/Claim Utilization, Enrollment, Networks (utilization, disruption, geo-access) and making recommendations based on the results of their data analysis.This includes benefits design analysis based on benefit utilization while factoring in financial analysis to determine cost impact.
• Representing UCD at Client meetings, including but not limited to, Open Enrollment meetings and Health and Wellness fairs.The Client Benefit Analyst is expected to sell at member level for both renewal and new business clients at open enrollment in addition to acting as an oral health wellness consultant at renewal and new business client wellness events.
• Other duties as assigned.

EDUCATION

Required

• Associate's Degree in Business Administration/Management

Substitutions

• 3 years of progressive related experience in lieu of Associate Degree

Preferred

• Bachelor's Degree in Business Administration/Management

EXPERIENCE

Required

• 3 - 5 years of Sales Support
• 1 - 3years in Insurance

Preferred

• 1 - 3 years of Dental Sales experience

LICENSES OR CERTIFICATIONS

Required

• Producer's License - Accident & Health, or within 45 days of hire.

Preferred

• None

SKILLS

• Analytical Skills
• Communication Skills

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Companys Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employees responsibility to comply with the companys Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

JOB SUMMARY

This job provides account support activities associated with the administration of all experience rated and community rated dental groups.The incumbent is responsible for providing or coordinating prompt support to UCCI Sales and Service personnel, group administrators, brokers, and Agent Plan personnel to ensure the resolution of issues related to benefit interpretations, customer service inquiries, claims adjudication, benefits issues, membership and billing activity, etc. This job is ultimately responsible for ongoing account retention, satisfaction, and administration, complementing the efforts of Sales and Service Executives. This activity is intensified and focused for new accounts.This additionally includes identifying and resolving problems related to benefit interpretations, rating concerns and any subsequent adjudication requirements. To this end, the incumbent cultivates and maintains efficient working relationships with key internal areas, such as Customer Service Operations (Claims, Dental Benefits, Customer Service, Membership & Billing),Provider Data Management, Underwriting, and Professional Relations.

ESSENTIAL RESPONSIBILITIES

• Provide account support activities associated with the administration of all experience rated and community rated dental groups.The Client Benefit Analyst is responsible for providing or coordinating prompt support to UCCI Sales and Service Personnel, group administrators, brokers, and Agent Plan personnel to ensure the resolution of issues related to benefit interpretations, customer service inquiries, claims adjudication, benefits issues, membership and billing activity, etc.
• Collect and analyze customer specific information including gathering data from multiple sources related to Benefit/Claim Utilization, Enrollment, Networks (utilization, disruption, geo-access) and making recommendations based on the results of their data analysis.This includes benefits design analysis based on benefit utilization while factoring in financial analysis to determine cost impact.
• Representing UCD at Client meetings, including but not limited to, Open Enrollment meetings and Health and Wellness fairs.The Client Benefit Analyst is expected to sell at member level for both renewal and new business clients at open enrollment in addition to acting as an oral health wellness consultant at renewal and new business client wellness events.
• Other duties as assigned.

EDUCATION

Required

• Associate's Degree in Business Administration/Management

Substitutions

• 3 years of progressive related experience in lieu of Associate Degree

Preferred

• Bachelor's Degree in Business Administration/Management

EXPERIENCE

Required

• 3 - 5 years of Sales Support
• 1 - 3years in Insurance

Preferred

• 1 - 3 years of Dental Sales experience

LICENSES OR CERTIFICATIONS

Required

• Producer's License - Accident & Health, or within 45 days of hire.

Preferred

• None

SKILLS

• Analytical Skills
• Communication Skills

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Companys Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employees responsibility to comply with the companys Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidates qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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Highmark Health is a national, blended health organization that includes one of Americas largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network.

Based in Pittsburgh, Pa., Highmark Healths 35,000 employees serve millions of customers nationwide through the nonprofit organizations affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services.

Highmark Healths businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.