See ES Benefits Technician.

Makes judgements and payment/adjustment determinations using established fee schedules, applicable state and federal laws, regulations and policies, processes edits coded by policy guidelines;

Resolves claimant/customer problems by identifying the issues, determining procedural steps necessary to bring resolution, working with program staff to implement resolution, and communicating results to the claimant/customer;

Determines rebuttal requirements and obtains additional facts; advises claimants and employers of final right and responsibilities;

May be required to oversee the training of lower level staff;

Calculates and prepares employer quarterly tax and wage reports;

Documents and verifies the recipients’ reason/explanation for requesting insurance benefits;

Conducts collection of routine insurance benefits overpayments;

Researches, reviews and corrects tax and wage reports prior to posting from suspense file; prepare assignments to District and Central Offices for resolution of errors;

Submit tax and wage adjustments to correct reporting errors and support claim determination;

Processes and adjudicates claims;

Obtains and reviews necessary data, such as employer premium/wage reports;

Explains program requirements and services available;

Initiates and answers correspondence concerning unique problems relating to eligibility;

Performs the duties of the lower levels in the series;

Performs other duties as required.

Knowledge of: Insurance benefits service programs, applicable state and federal laws, regulations and policies; office procedures and practices; interviewing techniques, letter and report writing; cultural diversity, principles of individual and group behaviors, social behaviors, social and economic conditions and their effects upon individuals; other community programs providing financial and health services.

Ability to: make independent conclusions and decisions; evaluate and recommend changes to insurance benefits program management; work cooperatively with members of the public and with co-workers; practice tact, courtesy and discretion; accurately document, listen, observe, communicate, confront and engage in problem solving and conflict resolution; convey interest and concern to claimants requesting information or assistance with problems related to insurance benefits programs and services.

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

One year as an ES Benefits Specialist 1.

  OR

A Bachelor's degree in a health or social science, public administration or a related field; and one year of experience examining and/or processing loan applications, medical insurance or rehabilitation claims, insurance claims, collection of insurance premiums, tax collection or providing staff support in financial eligibility determination.

  OR

A combination of education and relevant experience.

OR

One year of experience equivalent to the ES Benefits Specialist 1 with another state that administers insurance benefits programs.