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SSM Health Benefits Administration Specialist in Madison, Wisconsin

Divison:

-

PRIMARY RESPONSIBILITIES

  • Utilizing high level Excel skills, create and maintain interactive job aides that support the creation and quality assurance of benefit plan builds, benefit narratives and member facing documents.

  • Define, create, test and maintain detailed benefit plan designs. This includes the creation of templates to assign financial liabilities to benefit plans within the claims administration system.

  • Participate in departmental and cross-departmental activities related to the creation of benefit designs and benefit plan builds. Provide expert knowledge, analyses and technical recommendations to these teams.

  • Create and analyze reports for quality assurance activities to ensure that the plans in production in the claims system accurately reflect detailed plan designs. Complete all benefit remediation as required by quality assurance activities, regulatory changes, and benefit configuration modifications introduced throughout the year.

  • Create member facing documents including Summaries of Benefits and Coverages, Certificates of Coverage, and Schedules of Benefits utilizing Microsoft Office or other document management systems. Ensure that documents meet requirements from federal and state regulators. Publish documents to the Member Document Center for display on health plan websites for access by prospective and enrolled health plan members, agents, employers and health plan providers.

  • Configure, test and maintain benefit narratives for Electronic Data Interchange 270/271 transactions.

  • Provide production support for questions from across DHP related to member benefits and cost share accumulators.

  • Maintain and update technical and process documentation.

  • Support unit and patch testing for claim system upgrades

  • Perform training on processes related to assigned functional areas. Serve as subject matter expert for training within the department and across operations teams.

  • Performs other duties as assigned.

EDUCATION

  • High school diploma.or equivalent

EXPERIENCE

  • Four years' of health insurance experience in health plan administration, claims operations or benefit administration

  • PHYSICAL REQUIREMENTS

  • Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.

  • Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.

  • Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.

  • Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.

  • Frequent keyboard use/data entry.

  • Occasional bending, stooping, kneeling, squatting, twisting and gripping.

  • Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.

  • Rare climbing.

SSM Health is committed to equal employment opportunity based on race, color, religion, national origin, gender, sexual orientation, gender identity, pregnancy, age, physical or mental disability, veteran status, and all other statuses protected by law.

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