Occ. Code 2560100
EMPLOYEE INSURANCE EXAMINER 1, GRADE 11
EMPLOYEE INSURANCE EXAMINER 2, GRADE 14
New York State Department of Civil Service
BRIEF DESCRIPTION OF CLASS SERIES
The positions provide information, process transactions, and respond to correspondence for the New York State Health Insurance Program (NYSHIP) for health, dental, vision, and life insurance benefits. They communicate with enrollees, or state or local government agency Health Benefits Administrators (HBAs) in maintaining enrollee health benefit records.
These positions are only classified at the Department of Civil Service (DCS).
EMPLOYEE INSURANCE EXAMINER 1: full performance level; under the general direction of an Employee Insurance Examiner 2, answers New York State health benefits coverage and enrollment questions from enrollees and HBAs. The positions use various health and human resource information systems such as the New York Benefits Eligibility and Accounting System (NYBEAS), and must have knowledge of Civil Service Laws, rules and regulations that apply to employee benefits programs, and understand the purpose of the transactions.
EMPLOYEE INSURANCE EXAMINER 2: first supervisory; under the general direction of an Employee Benefits Representative 1, supervises a unit of Employee Insurance Examiners 1 and clerical staff.
various information systems to track and respond to telephone and electronic
inquiries from customers.
· Answers coverage questions regarding the rules and regulations of NYSHIP.
· Answers coverage questions regarding the impact of federal laws and programs such as HIPAA, COBRA and Medicare.
· Screens correspondences and answers requests for information regarding the rules and regulations of NYSHIP.
· Determines eligibility for coverage, start and end dates, and premiums based on union contracts and enrollment transactions.
· Processes or assists with completion of enrollment transactions.
· Computes past premiums due for retroactive transactions.
· Reconciles premiums due with direct payments made or deductions taken from payroll or retirement checks.
· Follows-up on delinquent accounts and cancels coverage, or arranges for payments.
· Drafts correspondence in reply to telephone requests from enrollees and HBAs.
· May assist with training agency HBAs.
EMPLOYEE INSURANCE EXAMINER 2
· Performs all the duties and responsibilities of an Employee Insurance Examiner 1.
· Performs the full range of supervisory responsibilities such as evaluating staff performance, staff training, and time and attendance.
EMPLOYEE INSURANCE EXAMINER 1
Open Competitive: Three years of experience* in a position dealing with the public or business representatives to gather information from multiple sources and prepare factual reports; and provide written and verbal information concerning laws, rules, regulations, policies, and/or procedures; OR,
Three years of experience* in a business office or human resources office in one or more of the following areas: accounts payable, accounts receivable, general office management and/or bookkeeping; health insurance, benefits administration and/or personnel and benefits transaction processing.
*Substitutions: 30 semester credit hours for one year of experience; 60 semester credit hours for two years of experience.
Promotion: One year of permanent service in an office assistant, clerical or keyboarding title allocated to Grade 6 or higher.
EMPLOYEE INSURANCE EXAMINER 2
Promotion: one year of permanent service as an Employee Insurance Examiner 1.
NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe. Standards cannot and do not include all of the work that might be appropriately performed by a class. The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written. Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.