Insurance Benefits Claims Processor Jobs in Rochester, WA

Description Benefits Eligibility Specialist (MAS3/ERB) This recruitment will be used to fill multiple positions Join our team as a Benefits Eligibility Specialist (Medical Assistance Specialist 3/MAS3) in the Employees and Retirees Benefits (ERB) Division. Support the PEBB and SEBB Programs by providing guidance on eligibility, insurance benefits, and enrollment through phone, email, and in-person interactions. Utilize a multi-line phone system, Benefits 24/7, and other tools to assist customers.

We're looking for someone with excellent communication, time management, and problem-solving skills, who can thrive in a fast-paced environment. Apply today and improve health care services for Washington residents. All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

About the division: The Employees and Retirees Benefits (ERB) Division manages a $5 billion budget to support over 725,000 individuals through two main programs. The Public Employees Benefits Board (PEBB) Program provides insurance and benefits to employees of state agencies, higher education institutions, and their dependents, including retirees and those eligible for COBRA. The School Employees Benefits Board (SEBB) Program offers coverage for employees of K-12 schools, Educational Service Districts, Charter Schools, and their dependents, also providing COBRA continuation.

Both programs aim to improve health outcomes, care quality, and cost efficiency through value-based purchasing and policies aligned with the Triple Aim framework. About the position: This position aligns with the HCA mission and Governor's health care priorities by providing support in the delivery of quality customer service to PEBB and SEBB Programs' subscribers and their dependents, including retirees, COBRA/continuation coverage, and K-12 members. This position provides these services via a customer service phone line, an online member portal called "HCA Support", email, mail, and in-person at Cherry Street Plaza.

This position is eligible to telework part-time and is required to report on-site 1-3 days a week to meet business need. The default assigned work location of all Health Care Authority (HCA) positions - both on-site and telework eligible positions - is within the State of Washington. This position reports to Olympia, WA.

Frequency of onsite work will vary based on business and operational needs. HCA has currently suspended the ability to support out-of-state telework. Duties Some of what you will do: Utilize a multi-line telephone and a toll-free line to administer customer service.

Use excellent communication skills and effectively communicate with customers and peers, utilizing a high degree of verbal and listening skills. Counsel customers on PEBB and SEBB Programs' eligibility, policies, procedures, insurance benefits, rights and responsibilities, access to services, and enrollment status via phone, in-person, email, and through our secure portal HCA Support. Assist customers in managing and navigating their electronic profiles and benefits elections in Benefits 24/7.

Utilize various database systems and software programs, which include but are not limited to: HRISD/PAY1, Benefits 24/7, DRS Secure Client Remote Terminal (CRT), Avaya, Microsoft Office, Service Now, and AX imaging system, in the performance of all duties. Troubleshoot log-in issues and direct customers with accessing their Benefits 24/7 account through Secure Access Washington (SAW). Independently analyze and process applications and documents for health benefits eligibility and enrollment.

Participate in committee and project teams as requested. Some examples include participating in process improvement feedback and activities, employee resource groups, team meetings, or HCA materials reviews. Attend and complete training courses.

Qualifications Required qualifications: Qualifying candidates will meet one of the following criteria options: Option 1: Bachelor's degree. One (1) year of experience as defined below. Option 2: Associate degree.

Three (3) years of experience as defined below. Option 3: Certificate of Medical Billing and Coding or closely related certificate program. Three (3) years of experience as defined below.

Option 4: Five (5) years of experience as defined below. Option 5: One (1) year as a Medical Assistance Specialist 2. The required experience includes one or a combination of the following: Providing direct client services or counseling of customers in the areas of health insurance, disability, or other related health benefits.

Public assistance eligibility determination. Health insurance premiums/claims processing, adjusting, and investigation. Other medical premiums/claims/eligibility related experience.

Experience researching and analyzing complex rules, regulations, or policies and utilizing research and analysis to make determinations, solve problems, or complete work while providing direct customer service either in person or on the telephone. Required Competencies: The ability to take action to learn and grow. The ability to take action to meet the needs of others.

Preferred qualifications: Ability to understand PEBB and/or SEBB Programs' information sources, including WACs, policies, and procedures. Superior communication, customer service, time management, and interpersonal skills. Experience working with computers and databases and software programs.

Ability to navigate several screens, web-based applications, and forms simultaneously. Adept at switching priorities at a moment's notice and able to complete tasks with multiple deadlines. Ability and willingness to work in a high-pressure, customer contact center/production environment.

Ability to achieve results and stay calm during stressful circumstances. Experience using the PAY1 and Benefits 24/7 system. How to apply: Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered.

Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach: A cover letter that specifically addresses how you meet the qualifications for this position Current resume To take advantage of veteran preference, please do the following: Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter. Please black out any PII (personally identifiable information) data such as social security numbers.

Include your name as it appears on your application in careers.wa.gov. Supplemental Information About HCA: Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible. There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery

Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents. What we have to offer: Meaningful work with friendly co-workers who care about those we serve Voices of HCA A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values A healthy work/life balance, including alternative/flexible schedules and mobile work options. A great total compensation and benefit package WA State Government Benefits A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby

Tuition reimbursement And free parking. Notes: This position is covered by the Washington Federation of State Employees (WFSE). Once the listed position(s) is(are) filled, this recruitment announcement may also be used to fill additional position(s) for up to sixty (60) days.

Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment. HCA is an equal opportunity employer.

We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA's mission.

Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply.

If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Angelic Matthews at Angelic.Matthews@hca.wa.gov The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply

E-Verify is a registered trademark of the U.S. Department of Homeland Security. Subscribe to our weekly newsletter to receive a list of new job postings at HCA.