TENTATIVE

                                                                                                            Occ. Code 2569100             

New York State Department of Civil Service

Classification Standard

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).

DISTINGUISHING CHARACTERISTICS

EMPLOYEE INSURANCE REVIEWING CLERK 1: entry-level; under the general direction of an Employee Insurance Reviewing Clerk 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 REVIEWING CLERK 2: first supervisory; under the general direction of an Employee Benefits Representative 1, supervises a unit of Employee Insurance Reviewing Clerks 1 and clerical staff.

RELATED CLASSES

          Office Assistants perform office support and clerical work to meet the requirements of agency programs.

          Call Center Representatives work at the various call centers of New York State.  Incumbents perform such tasks as providing information, over the telephone, to callers regarding state services and programs.

          Employee Benefits Representatives plan, coordinate, direct, manage, and support a wide variety of administrative activities associated with employee benefit programs such as health, dental, vision and life insurance plans; as well as workers compensation, income protection, and disability benefits.

ILLUSTRATIVE DUTIES

     EMPLOYEE INSURANCE REVIEWING CLERK 1

·       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.

·       May assist with training agency HBAs.

EMPLOYEE INSURANCE REVIEWING CLERK 2

·       Performs all the duties and responsibilities of an Employee Insurance Reviewing Clerk 1

• Maintains and administers quality control of the program by processing corrections request, reviewing target files and making appropriate changes to NYBEAS.

• Troubleshoots and resolves rejected transactions, and processes corrections in NYBEAS and related human resource information systems.

• Analyzes enrollment and accounting problems using NYBEAS and related human resource information systems, and provides guidance to enrollees, HBAs and staff.

• Responds to escalated health benefit program telephone calls from enrollees or HBAs.

• Processes refunds and writes correspondence to enrollees regarding account transactions and requests.

• Researches and reviews various reports, and take appropriate action.
• Reviews and explains technical and legal written material related to NYSHIP laws, rules and regulations.

• Clearly presents ideas orally and in writing to explain technical information to enrollees and HBAs.

·       Performs the full range of supervisory responsibilities such as evaluating staff performance, staff training, and time and attendance.

MINIMUM QUALIFICATIONS

EMPLOYEE INSURANCE REVIEWING CLERK 1

Open Competitive: successful completion of a 12 month traineeship.

EMPLOYEE INSURANCE REVIEWING CLERK 2

Promotion: one year of permanent service as an Employee Insurance Reviewing Clerk 1.

Date:  2/16

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.