GROUP BENEFITS ANALYST 1

AS611 $32,781 - $56,181
Creation Date: 07/28/2000
Change Date: 01/01/2025

FUNCTION OF WORK:
To provide services to plan members, agencies, state employees, school boards, and providers relative to all aspects of the Office of Group Benefits Plan.

LEVEL OF WORK:
Entry

SUPERVISION RECEIVED:
General from a Group Benefits Supervisor or other higher level employee.

SUPERVISION EXERCISED:
None.

JOB DISTINCTIONS:
Differs from Group Benefits Analyst 2 by the absence of experienced level work in health insurance responsibilities and related programs.

CORE COMPETENCIES:
IDENTIFIED BY STATE CIVIL SERVICE, CORE COMPETENCIES ARE THE KNOWLEDGE, SKILLS, ABILITIES AND BEHAVIORS BASED ON THE WORK TASKS OUTLINED IN THE EXAMPLES OF WORK. MORE INFORMATION ON THE SCS COMPETENCY MODEL CAN BE FOUND HERE.

Displaying Expertise	Focusing on Customers	Making Accurate Judgments
Thinking Critically	Using Data

EXAMPLES OF WORK:
EXAMPLES BELOW ARE A BRIEF SAMPLE OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. NOT ALL POSSIBLE TASKS ARE INCLUDED.

Reviews individual claim files to obtain historical information and claim status, to answer questions regarding the disposition of the claim, and to determine possible discrepancies.

Assists in conducting annual enrollment and orientation sessions which may involve statewide travel.

Reviews medical records to determine eligibility with respect to pre-existing condition limitations.

Researches and corrects possible errors pointed out by plan members, the Claims Audit Section, or staff determinations.

Determines eligibility and updates the plan member record to ensure that claims are paid based upon the most current and accurate eligibility data.

Prepares material related to provider matters requested by Management in order to inform network providers on policies and procedures relating to plan member benefits.

QUALIFICATION REQUIREMENTS:
MINIMUM QUALIFICATIONS:
Three years of experience in employee benefits, health services, health insurance claims processing, or contracts; OR

Six years of full-time work experience in any field; OR

A bachelor's degree.

EXPERIENCE SUBSTITUTION:
Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.