$31.40-$38.19 Hourly / $5,443.00-$6,619.00 Monthly / $65,312.00-$79,430.00 Yearly
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 support services to analysts or adjuster in processing claims and benefit entitlements.
2. Provides general information to City employees regarding retirement benefits, health and dental benefits, or worker's compensation benefits.
3. Researches records and accounts for prior membership, premium history, account discrepancies, requested information, buybacks, withdrawal status, payment history, prior claims, overpayments, underpayments, injury information, and adjustments in database.
4. Makes adjustments, and creates, updates, inputs, and maintains information in the computer software files or in the database.
5. Reviews, completes, and processes a variety of membership forms, medical claims, and medical only (worker's compensation) claims.
6. Conducts research on claims to determine appropriate rates to use for payment and refers claims needing further attention to an analyst or claim examiner.
7. Performs various calculations to support the determination of retirement, health services, or worker's compensation benefits.
8. Communicates with employees, dependents, human resources, and payroll personnel within citywide departments, representatives from outside agencies, medical practitioners, lawyers, and other professionals.
9. Responds to routine vendor and claimant tracer inquires on unpaid medical invoices and medical only claims.
10. Completes standard form letters, and maintains reports, logs, and records.
11. Acts as a verifier to check work performed by another technician at the end of the day.
12. Performs related duties and responsibilities as assigned.
Knowledge of: basic technical knowledge of employee benefits programs such as pension plans, worker's compensation, labor code, and medical terminology.
Ability to: perform accurate calculations following a prescribed format; problem solve to identify problems and make routine adjustments; research to gather meaningful information and perform routine analysis; speak and write in a clear, concise, and understandable manner to answer benefits questions; and establish and maintain effective working relationships, and assist in a polite, courteous manner.
Skill to: access and use computer software applications and database systems.
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.
1. Completion of two (2) years college-level course work; AND
2. One (1) year of verifiable clerical or technical experience administering employee benefits programs including: researching records, claims adjudication, database maintenance, reviewing forms, performing calculations, and responding to general inquiries; AND
3. Proficiency in the use of computers to perform word processing and to perform data entry/retrieval.
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.