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State of Washington

HEALTH INSURANCE BENEFITS SPECIALIST 4

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HEALTH INSURANCE BENEFITS SPECIALIST 4
163J
Abolished Date: 2012-11-09

Definition

Supervises Health Insurance Benefits Specialists or serves as a designated health insurance benefits technical expert.

Distinguishing Characteristics

Positions in this class fit into one of the following categories:  (1) supervises three or more Health Insurance Benefits Specialists; or, (2) in the Basic Health Plan (BHP) or Public Employee Benefits Board (PEBB) divisions, spends a majority of the time performing all of the following tasks:  researching information system-processing problems, performing user-acceptance testing prior to implementation to ensure proper functionality and documentation of system enhancements/changes, reviewing divisional program policies, and developing, evaluating, and conducting formal training for Health Insurance Benefits Specialists, other agency employees, and employer/employee groups regarding health insurance benefits and use of health insurance information processing services used by the Health Care Authority (HCA).

Typical Work

Reviews, evaluates, assigns work, recommends corrective action and staff selection, and ensures training of Benefits Specialists; 

Plans, develops and implements performance standards; 

Plans and organizes the work of Benefits Specialists;  

Coordinates and assists in developing training methods and policy and procedure manuals; 

Investigates and responds to member complaints and appeals for eligibility and benefits problem resolution; 

Develops and conducts formal training programs and presentation for Health Insurance Benefits Specialists regarding application of agency management information system, program policy, procedures, RCWs and WACs, eligibility and enrollment procedures, data processing and all account adjustment procedures utilizing various computer programs, and provides individual training; 

Develops written training and procedural documentation, visual aids, and procedures manuals; 

Participates in the development of policy, procedures and training plans for implementation of system or program changes; 

Performs system user-acceptance testing, analyzes test results and researches and resolves test problems; 

Monitors new trainee’s productivity, audits files, and informs supervisors of trainee’s progress; 

Performs other work as required.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position. 

Desirable Qualifications

Two years as a Health Insurance Benefits Specialist 2 or Benefits Specialist 2. 

OR 

One year as a Health Insurance Benefits Specialist 3 or Benefits Supervisor.

Class Specification History

New class: 7-1-98
New class code: (formerly 13227) effective July 1, 2007

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