Job Requisition Number: 24566. UC Berkeley's Student Health Insurance Office is seeking an experienced Insurance Case Coordinator & Benefits Supervisor.
The Student Health Insurance Office (SHIO) is located within UC Berkeley’s University Health Services. SHIO Highlights: •Responsible for the administration of the University of California’s mandatory Berkeley Student Health Insurance Plan (Berkeley SHIP) which is billed as part of the campus registration fees each semester. •Coordinates all member services for students enrolled in Berkeley SHIP, and conducts the insurance “waiver” program for students. •Coordinates the insurance program for student athletes in Intercollegiate Athletics.
University Health Services at the Tang Center provides comprehensive medical, mental health, insurance and health promotion services to all Berkeley students, and a variety of health programs for faculty and staff. Services are designed to minimize the impact of illness, emotional distress and injury on studies and work. Learn more about UHS by visiting https://uhs.berkeley.edu/employment
The Insurance Case Coordinator & Benefits Supervisor manages high level case coordination for the Student Health Insurance Plan and supervises front line staff for the insurance office. Involves protecting the institution from loss. Develops and coordinates activities and programs that are designed to promote accountability. Helps identify and minimize risk of all types, and strengthen effectiveness and efficiency of controls. Responsibilities include:
I. Berkeley Student Health Insurance Plan Case Coordination •Provides analyses for complex cases requiring high-level case coordination and customer service, working directly with all levels of UHS staff, plan members, members’ parents, providers and insurance brokers to determine the most appropriate resolution for the issue. Consult with Associate Director for Insurance and Medical Director as needed. •Coordinates efforts with a variety of external and internal contacts; cases may include complex insurance billing problems, provider-patient relations concerns, coordination of benefits for patients with dual coverage, management of coverage for patients with complex and/or chronic health care needs, substitution of benefits cases, negotiation of one-time payment agreements through insurance carrier and others. •Provides detailed information to clients regarding their health, dental and vision insurance plans, including benefits, premium rates, deductibles, exclusions and limitations, plan periods of coverage, waiver deadlines and application procedures. •Coordinates requests for Berkeley SHIP authorization for services outside UHS for complex cases. Acts as subject matter expert and provides technical assistance by working with students, parents, providers and insurance carrier to resolve complex claim issues. Identify cases requiring task assignments to field case directors or assignment to clinical staff or external provider/vendor. •Develops, implements, and administers risk management insured programs and operations with respect to insurance claims administration, contracts and loss prevention. Interprets insurance and other policies to ensure campus is not assuming third party liability for which it has no insurance coverage. •Implements and monitors control strategies and programs for vulnerable patients and complex care cases. •In conjunction with other Insurance Case Coordinator, administers claims for health insurance plan. Liaises with third parties and claimants to resolve in accordance with campus guidelines in a timely manner.
II. Customer Service/Benefits Supervisor: •Supervises four customer service/benefits representative staffs whom are responsible for handling calls from students, parents, internal clinicians, and outside providers. These staff are also responsible for coordinating the approvals for referrals and counseling members on benefits. •Responds to or develops resolutions for customer service escalations while reducing or managing risk for the organization and plan. •Helps the Associate Director manage the referral policies and processes. Responsible for ensuring timely and appropriate processing of insurance referrals and transmission to carrier. •Responsible for ensuring timely and efficient response to customer service inquiries regarding benefits, claims, eligibility, and case management issues via in-person, email, phone, fax, or HER communication with patients, providers, and carriers. •Serves as subject matter expert to Student Health Insurance Office and UHS staff on the interpretation of major medical insurance plan contracts, enrollment eligibility, benefit utilization and billing and reimbursement processes. Ensures that students leaving the University receive information about other health insurance plan options.
III. Gathers, analyzes, prepares and summarizes areas of potential loss recommends appropriate type and level of loss protection to be implemented. Advises Associate Director on specifications for broker or underwriter bids, evaluates bids, and recommends or concludes insurance contracts.
IV. Other duties as assigned.•Thorough knowledge in the following areas: risk management; insurance; analysis; accounting; knowledge of common campus-specific computer application programs; knowledge of campus processes and procedures; understanding of campus rules and regulations. •2 or more years of insurance or case management and supervisory experience. •At least 3 years of customer service employment experience. •Ability to set priorities, and creativity in problem solving. •Requires ability to present complex risk findings and make recommendations in a clear concise manner both in writing and verbally. •Experience with and knowledge of medical coding systems like ICD-10 and CPT codes. •Experience supervising staff preferred. •Strong collaborative and communication skills to respond to and partner with students, families, campus partners, medical providers, and insurance carriers. •Knowledge of health insurance industry (customer service, benefits counseling, claims processing or brokerage services). •Thorough knowledge of health insurance benefits and health plan design, based on 5 years of employment experience, or an equivalent combination of educational and employment experience. •Requires interpersonal, service oriented, active listening and critical thinking skills. •Knowledge of the HIPAA Privacy Rule and California state laws regulating privacy and confidentiality of health information. •Demonstrated ability to organize, coordinate and complete work and projects effectively and within deadlines. •Ability to function under fluctuating workloads, with frequent distractions and interruptions.
Education: •Bachelors degree in related area and/or equivalent experience/training in health care field; master’s or higher degree preferred. Employment is contingent on successful completion of: Background Check, Acceptable Medical Evaluation that includes infectious disease surveillance and proof of current required vaccinations or immunity levels.
The University of California was chartered in 1868 and its flagship campus - envisioned as a "City of Learning" - was established at Berkeley, on San Francisco Bay. Today the world's premier public university and a wellspring of innovation, UC Berkeley occupies a 1,232 acre campus with a sylvan 178-acre central core. From this home its academic community makes key contributions to the economic and social well-being of the Bay Area, California, and the nation.
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The mission of the University Risk Management and Insurance Association is to advance the discipline of risk management
in higher education.