This series is responsible for review and analysis of insurance benefits information obtained through source documents and claimant/customer interviews to ensure compliance with insurance benefits program standards. Positions in this series are responsible for verifying claimant wages, employers’ financial records and claimants’ medical or employment documentation. These positions collect and process tax and premiums from employers, assign, recalculate, update and adjust employers’ tax rate; perform claims processing, audit employers for compliance, collect overpayments and represent the agency through the administrative hearings process.

Performs routine para-professional duties related to insurance benefits programs, services, claims processing and provides program specific information to claimants and employers.

Under supervision or direction of a Benefits Specialist, positions spend the majority of time assisting higher level Benefits Specialists or performs assignments such as: answering questions about insurance benefits programs and services, general questions concerning eligibility and liability, via phone or electronic inquiries; processes insurance basic and continued claims, call message recording, pin resets, and address changes.

Processes initial and re-opened claims;

Identifies claimant/customer needs, clarifies information, research issues and provides solutions regarding insurance benefits programs and services;

Conducts telephone interviews, obtains work history, and verifies earnings and hours of work;

Initiates, receives and responds to routine inquiries and questions from claimant/customer, their representatives, employers, businesses, and healthcare providers about insurance benefits programs and services; clarifies, research, locates and provides information;

Assists Benefits Specialists in determining employer liability and verifying business activity descriptions for tax rates;

Prepares routine accounting adjustments on tax and wage reports when discrepancies are found;

Assists Benefits Specialists in resolving routine problems and clarifies issues; research answers and alternative solutions; implements solutions; escalates complex and unresolved problems and communicates results to the claimant/customer;

Communicates reporting requirements, benefits and eligibility rights to claimant/customer, employer and third parties;

Participates in process improvement workgroups;

Performs other duties as required.

Knowledge of: fundamentals of customer service and person-to-person communication; office practices and procedures; business English and letter writing; spelling and basic arithmetic.

Ability to: develop interviewing skills; learn to interpret and analyze data in accordance with established procedures; learn agency services; learn and understand the motivations for human behavior to work effectively with members of the public and co-workers.

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.

An Associate’s degree.

OR

2 years’ customer service experience.

Establishment, adopted June 22, 2023, effective July 1, 2023.