Job Description

The Eligibility Analyst is a hands-on position which requires a highly motivated, organized individual who is responsible daily administration of employee benefits such as life, medical with prescription drug, dental, vision and disability plans for the participants of contributing employers, posting the monthly contribution payments, and providing customer service to participants and contributing employers. Additional duties as assigned by the Eligibility Manager and Director of Operations.

DUTIES AND RESPONSIBILITIES

Employee Eligibility/Employer Billings

· Daily Administration for employee health benefits in accordance with the Summary Plan Description for the following benefits.

o Medical

o Dental

o Vision

o Short-Term Disability

o Life

· Provide customer service to assigned contributing employers and their participants.

o Research issues and provide appropriate response via telephone, email, letter and fax as applicable

o Provide back-up to BTF Analysts as necessary

· Maintain employee/dependent records in the benefit administration system

· Process enrollments, changes and terminations as well as applicable documentation for employee/dependents.

· Filing all eligibility, billing and other pertinent documents electronically and/or paper files

· Handle changes to an employer’s electronic record as well as participant census information;

· Process and input employee work hours where applicable;

· Research and request additional information relating to eligibility issues in timely;

· Generate, review and mail employer billings;

· Analyze employer remittance reports and post cash receipts along with monthly reconciliations of assigned accounts;

· Manage underpayments and delinquencies, including all reports and letters.

Administration

· Responsible for resolving vendor eligibility discrepancy reports on a weekly basis

· Generate and mail all denial of benefits letters to participants

· Generate and mail all eligibility notices to participants

· Generate QMSCO for Manager’s review

· Write appeals to present at quarterly Board of Trustees Meetings (BTM) from participants and contributing employers

· Write appeal response letters based on BTM decisions.

· Back-up Customer Service by answering employee questions about their benefits as well as directing escalated calls

JOB REQUIREMENTS:

• Bachelor’s Degree Preferred
• Minimum five-years experience with Health and Welfare
• Minimum five-years experience with employee benefits administration
• Minimum five-years experience with COBRA Administration
• Minimum five years of experience with data entry
• Requires strong communication skills, good writing skills, strong customer service and analytical skills.
• Ability to perform mathematical calculations in posting cash receipts and reconciliations
• Ability to work independently and in a team environment
• Above average computer navigation skills. Must be able to talk and type at the same time with an emphasis on accuracy of information, including use of multiple applications simultaneously.
• Ability to actively listen to contribution employers/participants and probe for clarification.
• Requires confidentiality, analyzing information and verbal communication of Summary Plan Descriptions to contributing employers and their employees.

Company Description

The IAM National Pension Fund is the 5th largest multiemployer pension fund in the United States with approximately $14 Billion in assets. The Fund has over 1,650 contributing employer locations and pays pension benefits to over 100,000 retires and beneficiaries, providing them with retirement security.