HealthTrust - Employment
Ancillary Services Representative
This is responsible technical and administrative work consisting of administering various services offered by HealthTrust to Member Groups and Enrollees. Work consists primarily of processing enrollment for participants in a Flexible Spending Account (FSA) or a Health Reimbursement Account (HRA); processing, investigating and adjudicating Short-Term Disability (STD) claims; and resolving related customer service inquiries.
Employee must apply critical thinking and detailed knowledge of enrollment and eligibility guidelines to review and screen enrollment requests and claims for accuracy and completeness. Employee will be responsible for working with Member Groups in both education and follow-up to questions identified through the application of enrollment and eligibility guidelines. The employee is responsible for accurately reviewing and processing the enrollment information within the HealthTrust enrollment and billing platform in a timely manner. In addition, the employee is responsible for reviewing enrollment information entered through self-service and Member Group file imports for accuracy and completeness and for resolving related discrepancies. The employee must maintain confidentiality at all times and must comply with internal policies and external regulations, including the Health Insurance Portability and Accountability Act (HIPAA).
The employee must maintain a strong level of knowledge regarding government regulations impacting health coverage eligibility, as well as HealthTrust underwriting and administrative rules. The employee exercises initiative, critical thinking, resourcefulness, judgment, and tact in working with Covered Individuals, Member Groups, and other HealthTrust employees in order to determine correct courses of action. The employee performs the position’s regular duties with little daily guidance. The Ancillary Services Coordinator or the Operational Services Manager is consulted when problems of an unusual nature are encountered.
Essential Duties & Responsibilities
1. Receives, verifies and audits employee FSA/HRA enrollment requests, electronic self-service transactions, and/or electronic files for eligibility, accuracy, and completeness. Utilizes critical thinking and attention to detail to accurately process enrollment information into the enrollment and billing platforms in a timely manner. Assists Member Groups with completing all necessary forms and processes for enrollment.
2. Adjudicates Short-Term Disability claims through thorough documented procedures, investigations and appropriate judgement. Uses extensive critical thinking and internal resources to ensure that the claim is processed accurately and in a timely manner. Documents detailed claim evaluations including the basis for payment in comprehensive electronic notes in the appropriate claims software system.
3. Coordinates Long-Term Disability (LTD) and Life claim administration with the HealthTrust’s fully insured carrier. This involves reviewing incoming claims, verifying coverage, submitting the claim to the Carrier. Additionally, acts as the liaison between
the claimant, Member Groups, and Carrier. Maintains detailed records on the LTD and Life claims by obtaining regular updates from the Carrier.
4. Provides exceptional customer service by responding to telephonic and written inquiries from Covered Individuals, Retirees, Benefits Administrators, vendors, and others relating to enrollment, benefits, services, claims, billing, and administrative
procedures for FSA/HRA and Disability/Life coverage offered by HealthTrust. Processes repayments to FSA accounts as applicable. Maintains the secure message center Benefit Advantage and Disability boxes as well as the email boxes. Completes
detailed, concise and accurate documentation of all inquiries in the contact-tracking database.
5. Maintains a strong and up-to-date level of knowledge of the various benefit programs offered by HealthTrust and associated administrative practices. Creates, maintains and regularly updates procedure manuals and other resources related to the activities
performed by Ancillary Representatives and promotes communication of changes to the team. Follows policies and procedures to ensure all appropriate administrative rules, underwriting guidelines, federal and state laws, and individual Group policy guidelines
are applied.
6. Ensures clean and accurate data is electronically transmitted to vendors. Regularly reconciles and researches eligibility and claims discrepancies through various reports between HealthTrust and its vendors; confirms membership and demographic changes
and reports findings of the audit and makes any necessary updates. Analyzes and completes various audits.
7. Assists the Contact Center Representatives, other departmental staff, Covered Individuals, administrators and vendors with questions relative to FSA/HRA and Disability/Life claims, enrollment, billing, and eligibility. Uses available resources to
research and resolve questions. Participates in User Acceptance Testing of system updates to ensure proper functionality.
8. Completes COBRA individual enrollments, billing administration processes and COBRA ending notifications.
9. Supports HealthTrust’s educational efforts by reinforcing key messaging during Member Group and covered individual interactions as directed by the organization. Assists with basic Member Group trainings, including Benefit Administrator Benefit
Advantage training sessions. Assists with newsletter articles on subject matter related to this position.
10. Keeps accurate, up-to-date records and files necessary to effectively process data and follow established procedures. This includes ensuring that accurate and complete notes and documentation are saved in the database system in accordance with applicable
internal procedures and records retention policies.
11. Performs special projects and other related duties or activities as required.
Minimum Requirements:
Possession of an Associate’s degree is preferred, ideally with course work in information processing, insurance, or a similar field. Prior work experience of at least two years in responsible customer service work is required, preferably in the field of health insurance,
claims processing or information processing. The employee must also demonstrate proficiency in computerized data entry and word processing. Possession of additional education or specialized courses/training in insurance, underwriting, or information
processing is highly desired. The position requires a high level of initiative, critical thinking, and organizational abilities. In lieu of the above, any equivalent combination of training and experience that provides the above referenced knowledge, abilities, and skills may be considered at the discretion of HealthTrust.
Please submit your résumé with cover letter for this position to hr@healthtrustnh.org
In addition to competitive salaries, HealthTrust provides a family-friendly work environment and offers excellent benefits including health, dental, and vision plans; life insurance; short-term and long-term disability insurance; a defined benefit pension plan and a deferred compensation plan; flexible spending accounts; and an on-site fitness center.
HealthTrust is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at HealthTrust are based on business needs, job requirements and individual qualifications, without regard to race, color, religion, age, sex, national or ethnic origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Salary: $43,000-$47,000
