Benefit Administrator Job Listing at Medical Mutual in United States of America (Job ID 2500121)

Description

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Benefit Administrator I - TPA 

Supports Benefit Administration in the installation and coding of routine and/or less complex medical, dental, vision and drug benefit designs for third party administration (TPA) customers.

Responsibilities:

• Installs new benefit designs with direction from more senior staff.
• Codes non-complex group benefits as directed by more senior staff.
• Assists in researching and resolving benefit inquiries and maintenance.
• Supports departmental participation in Corporate or Operational projects.
• Conducts peer audits and testing to ensure accuracy
• Creates and maintains procedural documentation and departmental files
• Maintains current knowledge base regarding company products/initiatives and changes in the health care industry and state/federal mandates.
• Performs other duties as assigned.

Benefit Administrator II - TPA 

Interacts with Sales, Service, Operations and third party administration customers to define and finalize most medical, dental, vision and drug benefit designs in compliance with state and federal mandates.  Coordinates workflow among business partners to expedite group / product Installation.  Codes benefits ensuring through peer audits that they are administered in accordance with the groups approved benefit design.

Responsibilities:

• Reviews and installs new benefit designs by coordinating the implementation of Medical, Dental, Vision and Drug benefits.  Ensures benefits can be systematically administered and meet state and federal mandates.
• Codes routine to moderately complex group benefits maintaining the highest level of automation possible.
• Resolves inquiries with minimal assistance by analysis and research, coordinating with Sales, Service and Operations as needed.
• Conducts peer audits to ensure accuracy
• Participates in projects as assigned by Management including but not limited to testing of new technologies, system upgrades, enhancements and/or system conversions.
• Creates and maintains procedural documentation and departmental files
• Maintains current knowledge base regarding company products/initiatives and changes in the health care industry and state/federal mandates.
• Performs other duties as assigned.

Qualifications

Benefit Administrator I - TPA 

Education and Experience:

• Bachelors' Degree in Business Administration or related field preferred, but will consider collective experience, training, and education.
• 5 years experience in health insurance claims and/or customer service or related operational area.

Technical Skills and Knowledge:

• General understanding of contracts (types, limitations), health care benefits (products, covered services, definitions, etc.), and claims adjudication.
• Understanding of corporate procedures, policies and benefits.
• Good analytical, research, problem solving and organizational skills.
• Ability to work independently with some direction.
• Intermediate Microsoft Office skills.

Benefit Administrator II - TPA 

Education and Experience:

• Bachelors' Degree in Business Administration or related field preferred, but will consider collective experience, training and education.
• 2 years as a Benefit Administrator I-TPA or equivalent experience in health insurance in a contracts, sales, system testing, or benefit administration capacity.

Technical Skills and Knowledge:

• Thorough understanding of contracts (types, limitations), health care benefits (products, covered services, definitions, etc.), and claims adjudication.
• Comprehensive understanding of corporate procedures, policies and benefits.
• Understanding of health care reform, state and federal regulations/mandates.
• Demonstrated analytical skills
• Ability to work independently
• Intermediate Microsoft Office and benefit administration systems skills.

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.