STATE HEALTH BENEFITS PLANS SPECIALIST SENIOR 27452

1/16/90 A

This is the second class in the Health Benefits plans series which administers state and local government health benefits; flexible benefits and cost containment plans for state employees, retirees and their dependents; and for local government, local officers, and school board employees, retirees and their dependents. This class interprets policies, determines compliance, provides technical expertise and training, resolves issues related to the programs, and leads cost containment efforts. This class is distinguished from the State Health Benefits Plans Specialist class by its responsibility for serving in a lead capacity with State Health Benefit Plans Specialists.

Complexity of Work: Performs work of considerable difficulty in interpreting program regulations and contract terms of the health benefits, flexible benefits and cost containment plans; communicating plan information, technical detail and training to state agency and local agency personnel directors and benefits administrators; determining statutory and regulatory compliance; resolving eligibility, coverage and denial disputes; conducting open enrollment activities; recommending policy and administrative modifications; and leading cost containment efforts.

Supervision Given: Supervision is typically not a factor, but the position serves in a lead capacity with program specialists.

Supervision Received: Receives direction from the State Health Benefit Plans Administrator in the form of a general outline of the work to be performed within established policies.

Scope: This class interprets and communicates health benefit and flexible benefit contract terms and program policies and regulations and trains benefit administrators of state agencies' and participating local agencies. It affects operational and administrative activities internal and external to the agency.

Impact of Actions: The performance and decisions of positions in this class can have a moderate impact on the agency's financial and employee relations posture because decisions and interpretations affect each state agency and participating local government agencies' health benefits, cost containment and flexible benefits programs.

Personal Contacts: This class has frequent internal contacts with benefit administrators in state agencies and frequent external contacts with benefit administrators in participating local agencies and with their employees, retirees and dependents; contractors on cost containment issues such as pre-admission and concurrent review, coordination of benefits, and utilization.

Knowledge: Considerable knowledge of health benefits claims systems. Working knowledge of program regulation, administrative policies and procedures; and state organization.

Skills: None identified for this class.

Abilities: Demonstrated ability to analyze data and derive logical conclusions; to interpret regulations and policies; and to communicate with diverse individuals.

QUALIFICATIONS GUIDE*

Licenses or Certification: None.

Education or Training: Graduation from high school with additional course work in personnel, public or business administration and training in health care administration.

Level and Type of Experience: Experience in employee health benefit programs.

An equivalent combination of training and experience indicating possession of the preceding knowledge and abilities may substitute for this education and experience.

This is a new class created by the Department of Personnel and Training in July, 1989.