INSURANCE CLAIMS TECHNICIAN
: Job Details :

Job Summary:Performs a wide range of personnel duties relating to the administration of the Life and Health Benefits plans.Duties and Responsibilities:Counsels newly hired employees concerning eligibility for life and health benefit plans including the policies, procedures, and plan provisions as well as procedures for filing claims. Ensures that appropriate forms are completed and forwarded to the insurance company for further processing. Assists employees on the completion of enrollment forms for the life and health benefit plans including short-term and long-term disability. Provides advice and assistance to on-board employees on benefits information. Follows through with the insurance company, other government activities, and employees' claimants to resolve discrepancies and problems.Conducts exit interviews for employees being terminated, resigning, or retiring. Advises employees regarding conversion privileges and other appropriate procedures to follow to affect those actions. Determines post-retirement benefits coverage for in-house and field personnel and prepares correspondence to advise retiring employees of continued coverage when appropriate. Follows up with field activities to ensure that original enrollment cards are forwarded to NEXCOM. May assist in preparations for pre-retirement counseling sessions for employees eligible for retirement.Processes death claims under the basic life, optional group life, dependent life, and special group life plans. Ensures that required documents are furnished and advises beneficiaries on procedures to receive benefits. Verifies earnings information, calculates, and determines the amount of death benefits, enrollment cards, certificates of death, and court appointment papers for designation of executor/administrator. Corresponds with field activities, insurance carriers, attorneys, etc., and transmits death benefit proceeds to beneficiaries or executors/administrators. Coordinates with and provides information to the Retirement Claims Unit as necessary.Initiates annual notices to retirees for follow-up on beneficiary change, current address, and reduction in the amount of insurance. Answers inquiries received from all retired participants. Coordinates certification of eligibility for medical benefits based on age. Issues medical identification cards to retirees.Monitors eligibility of NEXCOM employees for participation in the Long-Term Disability Program. Notifies employees upon completion of one-year waiting period, schedules counseling sessions, and ensures completion of enrollment refusal cards.Processes claims under the Short Term and Long-Term Disability Plans. Verifies eligibility for benefits, earnings information, leave balances, and ensures completeness of information provided. Calculates monthly benefits payable and applies other income offsets (e.g., Social Security awards, Workers Compensation benefits, Automobile No-fault, etc.). Transmits claims and current medical reports to the insurance company. Corresponds with field activities, claimants, insurance company representatives, attorneys, and attending physicians to ensure completeness of medical data submitted, answers inquiries on contract interpretation of benefits, and assists the insurance company in determining claimants' eligibility for benefits and disability status.Prepares monthly reports of approved disability claims including new addresses, discontinuance of payment adjustments due to retroactive Social Security, Workers Compensation benefits, Automobile No-Fault, and Return to Work Notices. Prepares correspondence necessary to transmit claim payments to individual claimants and/or field activities.Initiates correspondence to field activities and claimants pertaining to Waiver of Premium benefit for Permanent and Total Disability. Follows up with the insurance company and claimant while total disability status is certified.Certifies eligibility status of employees participating in the Life and Health Benefits Plans in accordance with Privacy Act requirements, responding to inquiries received from hospitals, insurance carriers, and other health agencies. Assists the insurance company in coordination of benefits with other group health plans.Reviews, processes, and coordinates with the insurance company new enrollments, changes in beneficiary, changes in dependent status, enrollments in health maintenance organizations, cancellation of plan benefits, and transfer of participants to newly assigned locations. Makes appropriate entries on HRIS system and follows up to ensure entries were affected for NAVRESSO employees.Processes field activities requests for supplies and applicable literature (e.g., insurance booklets, administrative manuals, forms, etc.).Maintains files and records related to above duties and ensures that information is complete and current. Researches files for information to be used in correspondence or reports pertaining to insurance claims. Cross-references information with Workers Compensation and Retirement plan cases. Compiles appropriate reports in connection with assigned functions. Ensures a variety of documents are forwarded for filling in personnel jackets.Assists as needed in other personnel and administrative areas. Types a variety of material such as memoranda, letters, benefits administration guidance letters, travel orders, travel claims, Personnel Actions, SS 129, and other required forms, reports, etc., related to the above duties.Assists in special projects including: a. Processing the Annual Audit and Participation Report for all overseas activities on manual payroll and U.S. Coast Guard Activities; b. Coordination of biennial enrollment for life and health benefit plans and annual enrollment for health maintenance organizations.Performs other related duties as assigned.GENERAL EXPERIENCE: Three years of experience in administrative or other responsible work that enabled the applicant to gain general knowledge of medical/dental and life insurance and benefit claims.OR SUBSTITUTION OF EDUCATION FOR EXPERIENCE: One year of academic study above the high school level may be substituted for nine months of experience, up to a maximum of a four-year bachelor's degree for three years of general experience.AND SPECIALIZED EXPERIENCE: Six months of experience in the application and adjudication of retirement and benefits claims and the various laws, regulations, and provisions of an organization's medical/dental and life insurance plan or other related medical/dental and life benefits claims experience of a non-clerical nature.#J-18808-Ljbffr