Job Details

Job Summary:

Assists employees, providers, and third-party administrators with eligibility and insurance claims filing processes; prepares and reconciles appropriate billing; strictly maintains multiple spreadsheet logs and records keeping systems; disseminates benefit eligibility and claims information to providers and employees; and assists in coordinating claims issues with the third-party administrator or insurance company.

Assists employees, providers, and third party administrator with eligibility and claims and/or loan filing processes. Verifies participation, eligibility, level, and type of benefit by telephone and/or written notice. Verifies and reconciles billing for self-administered and traditional benefit programs. Prepares reconciliation schedules reflecting adjusting/correcting entries for additions, deletions, type, eligibility, and services provided to insured. Prepares appropriate check request for payment obtaining authorized signature. Composes reports and correspondence. Maintains eligibility logs and files. Tracks participant eligibility and payments. Generates related reports. Conducts new employee orientation and/or open enrollment, enrolls eligible employees in respective benefit programs. Designs and conducts training on benefit related policies, processes, and regulations. Coordinates claim and/or loan filing process. Verifies eligibility and complies required paperwork. Submits completed documentation for appropriate signature. Maintains schedules and logs on various benefit programs. Reconciles payroll deduction with monthly billings. Prepares respective reports. Attends meetings. Other duties may be assigned.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

EDUCATIONAL REQUIREMENT

Associate's degree from two-year college or technical school in Business Administration or related field; or three years related experience and/or training; or equivalent combination of education and experience. May include two years or more of undergraduate college course work.

EXPERIENCE REQUIREMENT

An additional two years experience in a related business field is required. Prefer one year of experience in the insurance field.

CERTIFICATES, LICENSES, REGISTRATIONS

Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating.

OTHER SKILLS AND ABILITIES

Computer literate. Must be knowledgeable with word processing, spreadsheets, and graphic software; routine office equipment; must have excellent written and verbal communication skills.

OTHER QUALIFICATIONS

Employee must not and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIGs Cumulative Sanction Report, or the GSAs List of Excluded Providers, or listed on the OIGs List of Excluded Individuals/Entities (LEIE).

PHYSICAL DEMANDS

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel. The employee frequently is required to stand, sit, and talk or hear. The employee is occasionally required to walk; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds, and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT

The noise level in the work environment is usually moderate.