Accident Specialist

About The Company

PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utah’s public employees through high quality and competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. As a government entity, we embrace both a public mission and a commitment to creating customer value, excelling in the market, and improving healthcare. We offer a competitive salary with generous benefits, personal development in a positive team environment, and excellent work-life balance.

For most jobs, remote work is available for 9 out of every 10 workdays.

POSITION SUMMARY:

PEHP’s Life & Accident Specialists play an essential role in ensuring PEHP’s life and accident insurance products are offered to members in a fair, consistent, and financially responsible process. The Life & Accident Specialist I assists in the handling of coverage applications and claims processes. Successful performance for the position requires a genuine interest in helping others, the ability to learn about and share complex information about life and accident benefits, an ability to operate professionally while helping with emotional and sensitive situations, and a high level of commitment and dependability.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Receives and reviews life and accident insurance enrollment, determines degree of completion, and reviews premium statistics to ensure data transmitted by employers reconciles to the database.
• Updates program for approved coverage levels and prepares enrollment documents for scanning.
• Reviews imaged documents to assist in resolving enrollment discrepancies to determine enrollment/eligibility status.
• Retrieves medical and pharmacy history from the PEHP system.
• Prepares tracking sheets and assembles necessary documents for conducting an underwriting review.
• Provides requested information to Finance in response to billing questions.
• Receives and processes requests for refunds due to over payment of premiums, coordinates with accounting personnel as needed.
• Assists in the coordination of life enrollment for State exempt life; reviews members with dual coverage to ensure maximum amount is not exceeded.
• Generates pending death claims report, error reports, and biweekly termination reports and makes necessary enrollment and deduction changes.
• Generates letters requesting information to members.
• Mails life insurance certificates and coverage letters to members.
• Maintains regular and reliable attendance.
• Maintains strict confidentiality.
• Performs other related duties as required.

Education and Experience

High School diploma and one (1) year of related experience within the insurance industry, administrative experience, or an equivalent combination of education and experience.

Enrollment and Claims Processing experience preferred.

Knowledge, Skills, and Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position:

Required technical skills include the working knowledge of:

• Microsoft Office Suite.
• Proprietary and third-party software.
• Web-based applications.

Required mathematical skills include the ability to:

• Calculate figures and amounts such as discounts, interest, and percentages.
• Apply concepts of basic algebra.

Required basic knowledge of:

• Principles and practices of public insurance systems, particularly group life insurance.
• Life insurance laws, codes, policies, and procedures.

Must possess excellent communication skills:

• Read, analyze, and interpret general business periodicals, technical procedures, or regulations.
• Write routine reports, business correspondence, and procedure manuals.
• Communicate with management, staff, members, employers, and vendors to resolve problems.
• Negotiation techniques.
• Interact appropriate with members during difficult situations.
• Communicate effectively, verbally and in writing.

Must have the ability to:

• Analyze a variety of problems and make recommendations.
• Follow written and verbal instructions.
• Prioritize work.
• Perform within deadlines.
• Work well in a team environment as well as independently.
• Multi-task by handling a variety of duties in a timely and efficient manner.
• Follow through with assignments.
• Deal effectively with stress caused by workload and time deadlines.

The incumbent must always demonstrate judgment, high integrity, and personal values consistent with the values of URS.

Work Environment

Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing, and seeing. Common eye, hand, finger dexterity required to perform essential functions.