Insurance Specialist

Overview

Reporting to the Manager, Student Health Plan, and working within the Student Health Plan Office at University Health Services, the Insurance Specialist independently supports the day-to-day operations of Princeton University's Student Health Plan, optional dental and vision plans, and related policies. They provide superior customer service to enrollees in these plans, comprised of over 6,000 undergraduate students, graduate students, and dependents. They act as a resource regarding all plans and provide complex and detailed customer service to all plan members.

Responsibilities
Client Service and Support

Provides independent day-to-day administration of the Student Health Plan in compliance with benefit plan documents, federal and state regulatory requirements, and established policies and procedures. Provides detailed and complex written and verbal communications on insurance-related policies and procedures. Conducts daily in-person office hours Consults with and advises a diverse student population, parents, staff, etc., on benefit eligibility, plan provisions, claims, and other benefits related information. Acts as liaison with students, staff, insurance carriers, providers, etc., to expedite and resolve the prompt resolution of various benefit issues. Responds to student questions, provides, explains, or clarifies benefits information. Determines when specific benefit issues exceed the scope of responsibility and refers to Manager for prompt attention and resolution. Enters daily referrals for off-campus specialist care. Investigates, resolves, and reprocesses claims.

Student Health Plan (SHP) Administration

Coordinates internal enrollment processes to include benefit plan eligibility, tracking enrollment and completion data. Periodically interacts with Deans in the Graduate School, Registrar's Office, Dean of the College office, and other academic departments to ensure an overall smooth process and effective integration of processes and procedures. Interfaces directly and regularly with a diverse student and staff population, vendors, healthcare and insurance providers, etc., concerning policies, procedures, initiation and/or termination of benefits, and related enrollment issues, using current and changing knowledge of proprietary vendor systems to assist student participants. Coordinates various activities associated with the benefits enrollment process for both new students and the annual benefits enrollment period. Prepares benefit enrollment materials, provides assistance to Manager in the development of benefit communications, monitors the receipt of student benefit elections and performs necessary follow-up. Independently responds to policy and claims inquiries or routes them to vendor management. Applies independent judgment and discretion to authorize and prioritize work scheduling. Deals with highly complex, confidential and sensitive information during the course of daily work. Establishes and maintains necessary files to ensure accuracy and consistency of process. Makes independent decisions regarding daily operations as needed. Independently researches and processes claim reimbursements/payments in accordance with established policies and procedures. Investigates, resolves, and reprocesses referrals and benefit claims in compliance with established processes and procedures to ensure a timely and cost-effective outcome. Sets up and attends student benefits fairs and orientations. Prepares and delivers event materials. Actively participates in the continuous assessment and improvement of internal processes and the integration of related information and reporting systems to ensure the effective and efficient operations related to areas of responsibility. Continually keeps abreast of current and changing rules, regulations, procedures, and other benefits-related issues through attendance at educational and training sessions. Integrates and applies knowledge into daily plan administration.

Student Health Plan (SHP) Systems Administration

Ensures the ongoing accuracy of all student benefits records; e.g., enrollment data, student status, and related census information, through the development and maintenance of multiple internal and vendor databases. Supports enrollment management through the collection and electronic entry/upload of required information through MyUHS website and authentication of required documentation. Creates/updates/tracks all forms/listservs/databases, and other cyclical events/activities; edits/updates PowerPoint, Excel, and Word files; assembles information and correspondence.

Support of Department Operations

As a first-line contact for students, staff, etc., represents a positive image of the department and its services at all times. Promotes the department and benefit-related services offered to its diverse student population through the preparation of various benefit communications, ongoing maintenance and updating of department website, editing for print media and website content, preparation of event calendars, etc. Performs various administrative activities to contribute to the overall efficiency of department operations.

Financial Management

Tracks and categorizes student benefit costs to identify variances and support the development of annual benefit cost projections. Manages the accurate/compliant preparation and reconciliation of the student medical, prescription, dental, and vision plans. Processes purchases, reimbursements, vouchers, and other financial procedures related to SHP and Athletic Activity Fund. Reconciles financial assistance applications and spreadsheets for submittal to the Dean of the Graduate School medical emergencies fund.

Qualifications

ESSENTIAL QUALIFICATIONS
• Bachelor's degree.
• Strong understanding of benefit plans and insurance terminology.
• At least 3 years of benefits administration experience.
• Knowledgeable about healthcare market and related insurance models.
• Experienced in vendor management and operation of service providers.
• Familiar with financial review of activity, reporting, and data reconciliations.
• Excellent verbal, written communication skills and project management skills
• Strong analytical and judgement skills.
• High level of integrity, professionalism with balanced approach to problem solving.
• Highly organized with ability to manage multiple cases and activities.
• Knowledgeable in principles and methodologies (e.g., Plan-Do-Study-Act, Root Cause Analysis, measurement, data collection, and analysis) needed to support and lead Quality Improvement projects and activities and/or willing to attend UHS-based Quality Improvement basic training within first 6-months of hire.


PREFERRED QUALIFICATIONS
• Medicat experience preferred.
• Evidence of management of at least 1 project requiring new installation of benefits and writing of related communications.
• Familiarity with total work systems (such as the Institute for Healthcare Improvement, Accreditation Association for Ambulatory Health Care, and Baldrige National Quality Program); and reviewing and analyzing data.

Princeton University is an Equal Opportunity/Affirmative Action Employer and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status, or any other characteristic protected by law. EEO IS THE LAW

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