The purpose of this position is to review applications for benefits, to analyze each applicant’s work and retirement history and personal details to a large set of complex eligibility rules, and to determine each applicant’s eligibility for health benefits, pension benefits, surviving spouse’s benefits, widow’s pension, and/or death benefits. The Benefits Specialist analyzes and processes applications, determines eligibility, and communicates his or her decision. The Benefits Specialist also responds to applicant and beneficiary inquiries regarding application status or details of eligibility rules.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
Achieves defined individual monthly goals, regarding number of cases processed, quality of work, and turnaround time. Goals are set at an appropriate level to reflect the analytical, time-sensitive nature of this position. As needed, works with other employees, especially teammates, to assist in the achievement of team and department goals.
Verifies that benefit applications are complete and accompanied by required documentation and checks applications against appropriate contract and plan criteria to determine if eligibility requirements are met. Awards and/or denies benefit applications.
Enters work history and new eligibility records into computer database, updates or corrects existing eligibility records, and identifies and reports systems and program deficiencies and problems.
Provides mine workers with information concerning credited years of service for pre-retirement planning purposes and resolves credit hours reporting problems and discrepancies.
Determines month of entitlement for health or pension benefits, and calculates amount of monthly payment, retroactive months of payment, withholding, adjustments, etc. for pension benefits.
Contacts applicants to notify them of problems or discrepancies, explain requirements, and/or to obtain additional information.
Works with an assigned Benefits Assistant as appropriate, delegating to that person tasks such as collection of data, follow-up letters to beneficiaries, and organization of case files. Handles the role of the Benefits Assistant in that person’s absence or in times over workload overflow.
Communicates with applicants, pensioners, co-workers, local union or district officials, coal company officials, or other sources to resolve problems.
Responds to inquiries, verbally or in writing, from beneficiaries and applicants concerning the status of applications and approval or denial of benefits or adjustments.
Maintains an accurate paper and/or digitally imaged filing and retrieval system for pending applications, case-related documentation, and case folders. Maintains detailed records with chronological listing of actions taken (phone calls, correspondence, materials received, etc.), and tracks all correspondence and phone discussions. Follows department organization and documentation standards and practices so that any other employee can pick up a case and understand its status and the tasks needed for its completion. Maintains a collection of reference materials, manuals, etc., as required for performing assigned duties.
Serves the Eligibility Services department with expertise on one or more application type (health benefits, pension benefits, surviving spouse’s benefits, widow’s pension, and/or death benefits). May be assigned a workload of one or more application types as suits the department’s needs.
Maintains confidentiality of coal company and/or beneficiary records. Responsible for adhering to all Funds policies and procedures adopted to comply with the Health Insurance Portability and Accountability Act (HIPAA) governing the privacy, security, and use of protected health information.
Travels as required to conduct Funds’ business.
Other duties as assigned. Assists in day-to-day activities.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
Bachelor’s degree from an accredited college or university or a comparable degree program in Social Sciences, Sciences, Humanities, Social Services, Communications/Journalism, Public or Business Administration and/or Labor Relations PLUS one-year successful experience in a position utilizing extensive oral and written communication skills and doing interpretation and analysis of complex regulations and/or policies.
At least 48 semester credit hours from an accredited college or university in a field defined above PLUS three years of experience in a position utilizing extensive oral and written communication skills and doing interpretation and analysis of complex regulations and/or policies.
High school diploma or General Education Degree (GED) PLUS four or more years of experience utilizing oral and written communication skills, interpretation and analysis of complex regulations, policies and procedures, and analysis of data or statistics to identify and resolve problems or support policy recommendations of which three years of experience must be with the Funds’.
TECHNICAL, BUSINESS, and INDUSTRY KNOWLEDGE
Demonstrated ability to enter, edit, print, and protect data in a worksheet; use formulas to perform basic calculations such as adding, subtracting, dividing, and multiplying; ability to display information and use menus to perform spreadsheet commands. Demonstrated ability and willingness to efficiently use FMS or other web-based applications to maneuver and collect information, generate reports, and to manipulate data.
Demonstrated ability to read, analyze, and interpret detailed and complex resources materials, such as Coal Wage Agreements, plan documents, and processing manuals.
Basic knowledge of eligibility criteria and enrollment procedures for Medicare Part A and B and applicable state and federal regulations, and/or basic knowledge of pension management issues and terminology.
Intermediate – Ability to speak effectively before groups such as Funds’ employees, beneficiaries, or third-party administrator for purposes such as gathering information, providing advice or counsel or making recommendations regarding procedures or policies.
Intermediate – Ability to read and interpret documents such as operating instructions, procedures, and processing manuals. Ability to write reports, business correspondence and procedure manuals.
Intermediate – Ability to accept positive and negative feedback from Team Leaders and Managers. Ability to communicate effectively and with appropriate sensitivity with colleagues. Ability to communicate effectively and with appropriate sensitivity with applicants.
Intermediate – Ability to interpret formulas and make calculations. Ability to calculate retroactive payments, monthly pension payments, and adjustments with and without assistance of the FMS system.
CERTIFICATES, LICENSES, REGISTRATIONS
DEMONSTRATION OF REQUIRED COMPETENCIES
Must pass at defined levels:
- A test which measures the candidate’s ability to communicate effectively in writing, and
- A test of the candidate’s ability to apply complex regulations to specific situations.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand and walk. Specific vision abilities required by this job include close vision, and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
90 standard workdays pursuant to Sections 5.06, 5.07 and 5.08 of the Collectively Bargained Agreement.
COMPLETE BACKGROUND CHECK REQUIRED.
Employee assistance program
Flexible spending account
Paid time off
Professional development assistance