1210-Benefits Analyst

Job description

CITY AND COUNTY OF SAN FRANCISCO

DEPARTMENT OF HUMAN RESOURCES

JOB CODE TITLE: BENEFITS ANALYST

JOB CODE: 1210

DEFINITION

Under general supervision, performs professional benefits work for the Health Service System's Membership and Medical Claims Divisions and performs related duties as required. Explains the City's health, dental, vision, prescription, disability plans, Flexible Spending Accounts, and Dependent Day Care and Medical Reimbursement programs.

DISTINGUISHING FEATURES

Class 1210 Benefits Analyst is the professional journey level in the Benefits series. This class is distinguished from the 1209 Benefits Technician in that the latter performs technical and support functions, while the Analyst performs a full range of complex and analytical duties within a framework of established procedures. The journey level is distinguished from supervisory professional levels in that the former class has no supervisory responsibility over Benefits Analysts.

SUPERVISION EXERCISED

May exercise technical and functional supervision over technical/clerical staff.

EXAMPLES OF IMPORTANT AND ESSENTIAL DUTIES

According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are not intended to be an inclusive list.

1. Provides written and oral information to members, retirees, medical providers and other interested parties regarding active and retired employee health and welfare benefit programs.

2. Advises and counsels members, retirees, and surviving spouses or domestic partners on available benefits, pursuant to rules and regulations of the Health Service System and federal and state laws.

3. Analyzes and resolves member claim problems.

4. Processes complex claims, and disburses benefits for the Health Service System.

5. Initiates, compiles, calculates, and processes adjustments to member records, premium receivables and medical claim histories.

6. Researches, reconciles, and resolves various member problems related to membership, eligibility, premiums, and medical claims accounts.

7. Interacts frequently and provides training when necessary to subordinate staff engaged in membership enrollments, terminations, accounts receivable, collection, and medical claims adjudication.

8. Consults with plan providers and department representatives regarding the member's status.

9. Conducts workshops for potential retirees and new hires regarding benefits, plans, costs, etc. and assist with the completion of required paperwork. Gives presentations to departmental orientations.

10. Processes and collects manual payments from employees on leave of absence, under COBRA, and retirees.

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of: technical administration of employee benefit programs including health, dental and disability plans, flexible spending accounts, and applicable federal and state laws; medical and legal terminology including the California Procedural Terminology (CPT) coding; and third-party liability and coordination of benefits, including Worker's Compensation.

Ability or Skill to: speak clearly to express ideas in a concise, understandable, and effective manner to disseminate benefits information and to conduct effective interviews; communicate effectively in writing by composing and preparing clear and concise correspondence and reports; identify and resolve complex problems in depth by analyzing and interpreting HSS rules and regulations, and numerical data; establish and maintain effective working relationships with those contacted in the course of work; make accurate benefits calculations; and use a computerized data system and various software applications.

MINIMUM QUALIFICATIONS

These minimum qualifications establish the education, training, experience, special skills and/or license(s) which are required for employment in the classification. Please note, additional qualifications (i.e., special conditions) may apply to a particular position and will be stated on the exam/job announcement.

Education:

Possession of a baccalaureate degree from an accredited college or university

Experience:

One (1) year of verifiable experience administering benefit programs including: initiating membership records, calculating benefit premiums and processing enrollment applications; processing, researching and/or adjusting benefit claims or problems and updating data

Substitution:

Additional experience as described above may be substituted for the required education on a year-for-year basis. Thirty (30) semester units/forty-five (45) quarter units equal one year of experience.

SUPPLEMENTAL INFORMATION

PROMOTIVE LINES

ORIGINATION DATE:

11/17/1994

AMENDED DATE:

06/15/01; 08/04/23

REASON FOR AMENDMENT:

To accurately reflect the current tasks, knowledge, skills & abilities, and minimum qualifications.

BUSINESS UNIT(S):

COMMN

Standard information

Disaster service work

All City and County of San Francisco employees are designated Disaster Service Workers through state and local law (California Government Code Section 3100-3109). Employment with the City requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

Historic and future compensation