Beneficiary Assistant

Job Description

SUMMARY

The purpose of this position is to receive office visitors; handle telephone calls to and from applicants and beneficiaries; review and respond to selected eligibility, written health and pension benefit inquiries; perform all mail room duties; provide limited telephone backup support and provide general administrative support for call center activities.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

Receives visitors and answers general eligibility, pension benefits and health benefits questions; directs visitors to appropriate staff for more complex issues.

Answers, screens, and directs visitors and callers; takes concise messages and delivers them to appropriate person.

Provides phone assistance to field representatives and social workers who are helping mine workers and beneficiaries directly.

Handles all mail room activities, including retrieving, opening, stamping, sorting, counting, distributing, and reporting of incoming mail. Handles outgoing mail activities, including collecting, applying postage and delivering to the Funds’ mailbox. Prepares overnight and other special mailings, as needed.

Monitors fax machines, sends faxes, and delivers incoming faxes to appropriate person. Operates copy machine and other office equipment as needed.

Handles the review and data entry of certain Funds’ mail or email received from beneficiaries and healthcare providers. Composes written responses to letters, emails and / or telephone calls.

Assists applicants in completing applications and forms, and screens applications and supporting documents for completeness and correctness, according to specified procedures.

Provides limited call center telephone support, answering questions concerning general eligibility for pension and health benefits, as needed.

Communicates orally and in writing with beneficiaries, applicants, healthcare providers, Union representatives and coal company representatives regarding general eligibility, pension benefits and health benefits.

Updates or corrects information on computer database systems. Uses Funds’ software, including FMS, Heat Call Tracking system and vendor claims systems. Also, uses software such as Access, Excel, Word, and SharePoint.

Introductory level knowledge of Funds’ policies and procedures; Medicare regulations; as well as medical, prescription, and medical management claims processing systems. Competent to perform limited claims review duties.

Makes outbound “welcome calls” to new beneficiaries during times of auto-enrollment, advising new members of benefit information, temporary ID card mailings, and their mandatory Medicare Parts A and B enrollment, if eligible.

Assists beneficiaries and healthcare providers with health benefits claims and / or billing problems.

Places outbound calls to beneficiaries and medical providers to obtain or share necessary information concerning pension benefits, eligibility and health benefits, or special projects.

Research outstanding reimbursement checks from the medical claims vendors and contacts the appropriate beneficiary, by phone or by mail, to determine whether the check was received or needs to be cancelled and reissued.

Research demographic and contact information of beneficiaries when conflicting information is identified, including researching claims history, contacting the beneficiary, HIPAA Authorized Representatives or healthcare providers.

Updates beneficiary death records received from family members, funeral homes, and other outside sources.

Assists beneficiaries regarding various special programs and projects, such as the Eligibility Questionnaire Program, Annual Pension Bonus payments, Annual 1099-R and 1095 Tax form mailings, Annual Funding Notice mailings, and the Annual Coordination of Benefits (COB) mailings.

Participates in periodic Medicare Audits, updating spreadsheets, databases, and contacting healthcare providers to obtain medical records, follow-up documentation and record notes.

Accesses Funds’ databases and Funds’ vendor databases as needed.

Maintains beneficiary records, compiles statistical data, and prepares reports as directed by the manager.

Maintains confidentially 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.

Assists with special projects and day-to-day activities.

QUALIFICATIONS

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

High school diploma or General Education Degree (GED) PLUS two years of prior experience interacting with people by providing them with assistance and helping to solve their problems which includes, but is not limited to, receiving and routing visitors, answering high volume of telephone calls, performing general administrative duties, and interpreting basic regulations, policies, and procedures.

TECHNICAL, BUSINESS, and INDUSTRY KNOWLEDGE

May be required to use spreadsheet applications such as Excel, Word, SharePoint or Access.

Demonstrated ability to operate office equipment including, but not limited to, personal computers with call management applications, copier machines, fax machines, and postage machines.

COMMUNICATION SKILLS

Intermediate - Ability to speak effectively before groups such as Funds' employees, beneficiaries, or third-party administrators for purposes such as gathering information, providing advice or counsel, or making recommendations regarding procedures and / or policies.

Intermediate - Ability to read and interpret documents such as operating instructions, procedures manuals, and processing manuals. Ability to write reports, business correspondence and procedures manuals.

MATHEMATICAL SKILLS

Basic - Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

CERTIFICATES, LICENSES, and REGISTRATIONS

None.

PHYSICAL DEMANDS

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 employee must occasionally lift and / or move up to 10 pounds.

WORK ENVIRONMENT

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. During periods of travel, noise level may be variable.

PROBATIONARY PERIOD

90 standard workdays pursuant to Sections 5.06, 5.07, and 5.08 of the Collectively Bargained Agreement.

COMPLETE BACKGROUND CHECK REQUIRED.