Insurance Specialist
Requisition # 2022-16149
Date Posted 7 hours ago(2/16/2023 3:21 PM)
Department
Health Services
Category
Health Services
Job Type
Full-Time
Overview
Reporting to the Manager, Student Health Plan, and working within the Student
Health Plan Office at University Health Services, the Insurance Specialist
independently supports the day-to-day operations of Princeton University's
Student Health Plan, optional dental and vision plans, and related policies.
They provide superior customer service to enrollees in these plans, comprised
of over 6,000 undergraduate students, graduate students, and dependents. They
act as a resource regarding all plans and provide complex and detailed
customer service to all plan members.
Responsibilities
Client Service and Support
Provides independent day-to-day administration of the Student Health Plan
in compliance with benefit plan documents, federal and state regulatory
requirements, and established policies and procedures.
Provides detailed and complex written and verbal communications on
insurance-related policies and procedures.
Conducts daily in-person office hours
Consults with and advises a diverse student population, parents, staff,
etc., on benefit eligibility, plan provisions, claims, and other benefits
related information. Acts as liaison with students, staff, insurance
carriers, providers, etc., to expedite and resolve the prompt resolution
of various benefit issues. Responds to student questions, provides,
explains, or clarifies benefits information. Determines when specific
benefit issues exceed the scope of responsibility and refers to Manager
for prompt attention and resolution.
Enters daily referrals for off-campus specialist care. Investigates,
resolves, and reprocesses claims.
Student Health Plan (SHP) Administration
Coordinates internal enrollment processes to include benefit plan
eligibility, tracking enrollment and completion data. Periodically
interacts with Deans in the Graduate School, Registrar's Office, Dean of
the College office, and other academic departments to ensure an overall
smooth process and effective integration of processes and procedures.
Interfaces directly and regularly with a diverse student and staff
population, vendors, healthcare and insurance providers, etc., concerning
policies, procedures, initiation and/or termination of benefits, and
related enrollment issues, using current and changing knowledge of
proprietary vendor systems to assist student participants.
Coordinates various activities associated with the benefits enrollment
process for both new students and the annual benefits enrollment period.
Prepares benefit enrollment materials, provides assistance to Manager in
the development of benefit communications, monitors the receipt of student
benefit elections and performs necessary follow-up.
Independently responds to policy and claims inquiries or routes them to
vendor management. Applies independent judgment and discretion to
authorize and prioritize work scheduling. Deals with highly complex,
confidential and sensitive information during the course of daily work.
Establishes and maintains necessary files to ensure accuracy and
consistency of process. Makes independent decisions regarding daily
operations as needed.
Independently researches and processes claim reimbursements/payments in
accordance with established policies and procedures. Investigates,
resolves, and reprocesses referrals and benefit claims in compliance with
established processes and procedures to ensure a timely and cost-effective
outcome.
Sets up and attends student benefits fairs and orientations. Prepares and
delivers event materials.
Actively participates in the continuous assessment and improvement of
internal processes and the integration of related information and
reporting systems to ensure the effective and efficient operations related
to areas of responsibility.
Continually keeps abreast of current and changing rules, regulations,
procedures, and other benefits-related issues through attendance at
educational and training sessions. Integrates and applies knowledge into
daily plan administration.
Student Health Plan (SHP) Systems Administration
Ensures the ongoing accuracy of all student benefits records; e.g.,
enrollment data, student status, and related census information, through
the development and maintenance of multiple internal and vendor databases.
Supports enrollment management through the collection and electronic
entry/upload of required information through MyUHS website and
authentication of required documentation.
Creates/updates/tracks all forms/listservs/databases, and other cyclical
events/activities; edits/updates PowerPoint, Excel, and Word files;
assembles information and correspondence.
Support of Department Operations
As a first-line contact for students, staff, etc., represents a positive
image of the department and its services at all times.
Promotes the department and benefit-related services offered to its
diverse student population through the preparation of various benefit
communications, ongoing maintenance and updating of department website,
editing for print media and website content, preparation of event
calendars, etc.
Performs various administrative activities to contribute to the overall
efficiency of department operations.
Financial Management
Tracks and categorizes student benefit costs to identify variances and
support the development of annual benefit cost projections.
Manages the accurate/compliant preparation and reconciliation of the
student medical, prescription, dental, and vision plans.
Processes purchases, reimbursements, vouchers, and other financial
procedures related to SHP and Athletic Activity Fund. Reconciles financial
assistance applications and spreadsheets for submittal to the Dean of the
Graduate School medical emergencies fund.
Qualifications
ESSENTIAL QUALIFICATIONS
• Bachelor's degree.
• Strong understanding of benefit plans and insurance terminology.
• At least 3 years of benefits administration experience.
• Knowledgeable about healthcare market and related insurance models.
• Experienced in vendor management and operation of service providers.
• Familiar with financial review of activity, reporting, and data
reconciliations.
• Excellent verbal, written communication skills and project management skills
• Strong analytical and judgement skills.
• High level of integrity, professionalism with balanced approach to problem
solving.
• Highly organized with ability to manage multiple cases and activities.
• Knowledgeable in principles and methodologies (e.g., Plan-Do-Study-Act,
Root Cause Analysis, measurement, data collection, and analysis) needed to
support and lead Quality Improvement projects and activities and/or willing to
attend UHS-based Quality Improvement basic training within first 6-months of
hire.
PREFERRED QUALIFICATIONS
• Medicat experience preferred.
• Evidence of management of at least 1 project requiring new installation of
benefits and writing of related communications.
• Familiarity with total work systems (such as the Institute for Healthcare
Improvement, Accreditation Association for Ambulatory Health Care, and
Baldrige National Quality Program); and reviewing and analyzing data.
Princeton University is an Equal Opportunity/Affirmative Action Employer and
all qualified applicants will receive consideration for employment without
regard to age, race, color, religion, sex, sexual orientation, gender identity
or expression, national origin, disability status, protected veteran status,
or any other characteristic protected by law. KNOW YOUR RIGHTS
Standard Weekly Hours
36.25
Eligible for Overtime
Yes
Benefits Eligible
Yes
Probationary Period
90 days
Essential Services Personnel (see policy for detail)
Yes
Physical Capacity Exam Required
No
Valid Driver's License Required
No
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