City : Burnaby

Category : Health Insurance

Industry : Insurance

Employer : Pacific Blue Cross

Job Summary

Under the general supervision of the Team Leader and on an assigned basis, performs Plan Administrator functions in one, some or all of the following areas of operation:

Hour Bank Benefit Plans Administration

Provides a wide range of administrative services to PBC clients, members, trustees, custodians and unions for hour bank plans designed to provide continuing benefit plans coverage based on accumulated hours worked for single or multiple employers on a month by month basis.

Non-Hour Benefit Plans Administration

Provides a wide range of administrative services to PBC clients, members, employers and unions for non-hour benefit plans designed to provide benefit plans coverage for salaried groups with continuing employment.

Disability and Life Claims Administration

Administers incoming weekly indemnity/wage loss claims to process and expedite payment for claims meeting qualifying criteria, initiates long-term disability claims for selected plans where short-term wage loss claims are reaching maximum coverage, confirms death or life waiver benefits and coordinates payment with carriers.

Pension Plan Administration

Administers one or more assigned pension plans to ensure clients, members, trustees, custodians and other stakeholders receive contracted services in accordance with established standards of service quality, accuracy and turnaround time.

All Plan Administrators provides a variety of accounting administrative support services to health benefit plans clients for hour bank, non-hour benefit plans and special fund plans to ensure timely and accurate production of monthly bank reconciliations, and synoptics, financial statements, billings and accounts payable. Maintains and update health benefit plan system data sources when plan changes are made by trustees and adds new groups and employers to a variety of technology platforms. Provide a variety of customer service and team support activities. May perform the primary TMSS Scheduler role for the department.

Job Duties

On an assigned basis, performs Plan Administrator functions in one, some or all of the following areas of operation:

Hour Bank Benefit Plans Administration.

Provides a wide range of administrative services to Pacific Blue Cross clients, members, trustees, custodians and unions for hour bank plans designed to provide continuing benefit plans coverage based on accumulated hours worked for single or multiple employers on a month by month basis by:

- receiving employer submissions of hours worked for new employees and those already qualified for coverage, keying hours into PBC’s online systems, tracking hours, determining eligibility for benefits coverage based on each plan’s business rules and policy requirements and processing claims for all types of benefit coverage;

- seeking direction from plan custodians for administering exceptions to plan provisions such as new employees not signed up with the applicable union, employees working on special projects with “no money hours” or requests for wage loss benefits prior to accumulating sufficient qualifying hours;

- enrolling new and reinstated employees on hour bank plans and on individual components of the plan including accessing the provincial MSP system when plan criteria has been met;

- preparing and distributing information packages and enrolment forms to new members and processing upon return;

- issuing enrolment and drug cards;

- keying status changes and terminations in online systems;

- monitoring status of self-pay plans and advising member of available options for continuing coverage;

- entering, balancing and reconciling monthly self-pay withdrawals and deposits, monitoring available funding for self-insured plans, and flagging pending claims or plan usage where funds are insufficient;

- maintaining records of disability credits for selected plans;

- releasing previously rejected claims for payment following approval;

- issuing templated confirmation of coverage letters for students who are classified as dependents on member request;

- producing reciprocity reports for members with multiple employer coverage and initiating requests for inter-local payments;

- producing annual Union dues receipts for selected plans.

Non-Hour Benefit Plans Administration

Provides a wide range of administrative services to Pacific Blue Cross clients, members, employers, agents, insurance companies and unions for non-hour benefit plans designed to provide benefit plans coverage for salaried groups with continuing employment by:

-receiving notifications of new employees from online and manual sources and determining eligibility based on group contract provisions and regulatory requirements;

- keying rates, policy numbers, class structures, waiting periods and salary data into PBC’s online system modules and accessing the provincial MSP system and other online portals to enroll new employees;

- for late enrolments or employees with pre-existing or historical conditions influencing status of coverage, validating status with plan underwriters, distributing health questionnaires, communicating restrictions imposed by carriers and facilitating the smooth flow of information between all stakeholders;

- confirming termination dates through analysis of plan usage, plan type and cost where extenuating circumstances are encountered, such as late receipt of termination information from employers;

- keying status changes and terminations in online systems;

- setting up new groups on PBC’s online and related systems and distributing welcome packages;

- investigating status of self-insured plans where funding is insufficient, reviewing claims experience reports to determine status of incoming and outgoing fees, expenses, taxes and pending claims, advises employers/unions of plan status and processes incoming deposits;

- analyzing concerns identified by employers/unions affecting individuals or groups of employees covered by the plan such as unique claim situations where employers wish to accommodate employee situations that are not consistent with plan design, identifying options to facilitate coverage or escalating to senior plan specialists where cost or impact is significant;

- processing additional reimbursement benefit forms where exceptions are to be funded and advising Claims Administration to adjudicate related claims;

- calculating claw back amounts for disability claimants receiving employment insurance benefits to cover waiting periods between short-term and long-term disability benefits;

- collecting unpaid premiums;

- issuing templated confirmation of coverage letters for students who are classified as dependents on member request;

- conferring with actuaries where annual rate changes impact surcharges and credits for selected plans, and initiating adjustments.

Disability and Life Claims Administration and Processing

Administers incoming weekly indemnity/wage loss claims to process and expedite payment for claims meeting qualifying criteria by:

-confirming eligibility, waiting periods, effective dates and volume of coverage and reviewing applications and supporting medical information in accordance with plan policy requirements and online resources;

- keying claims into the automated wage loss system, setting up payment schedules, calculating taxes and flagging dates for future actions such as obtaining follow up medical reports;

-attaching scanned claim forms, reports, emails, phone notes and any other documents relevant to the claim;

- initiating follow up phone calls with members, employers, doctors and allied health care practitioners to clarify status of the claimant and monitor progress;

- arranging for additional procedures such as diagnostic tests, surgeries, independent medical examinations or specialist referrals where indicated by the claimant’s treatment plan;

- consulting with internal policy specialists and BC Life adjudication specialists or referring unique situations to trustees where decisions with a significant cost impact are to be made;

- monitoring claims with overpaid status;

- monitoring claims waiting for third party settlement through ICBC, WorkSafe or other agencies and facilitating short term loan agreements in accordance with the terms and conditions of the trust agreement for each applicable plan;

- terminating claims where wage loss maximums have been reached or when claimants return to work;

- rejecting claims where medical information is insufficient to justify coverage, in accordance with established policy guidelines.

Initiates long term disability claims for selected plans where short-term wage loss claims are reaching maximum coverage by confirming long term disability coverage and benefit level for claimants and preparing long term disability packages prior to expiration of short-term wage loss claims where claims may potentially transition to LTD. Distributes packages to claimants and forwards completed documentation including claimant short-term disability history to LTD carrier company or Work and Wellness for processing. Follows up with carrier to track status of claims decisions, and maintains liaison between claimants and carrier in the event of issues with coverage or communication.

Receives written notices or phone calls from dependents, executors or beneficiaries advising of deceased claimants and those receiving short or long-term disability coverage prior to death, confirms death or life waiver benefits for insured and self-insured members, compiles documentation packages for completion by surviving spouse or other contacts and forwards to carrier company for processing once received. Locates missing beneficiaries using reasonable and best efforts. Maintains liaison with trustees where eligibility or circumstances require intervention. Tracks life insurance claims statistics and status, and prepares and reconciles annual reports for carriers.

Produces a variety of standard reports for all disability claim types to track claims status such as maximum benefits received, member age considerations for those receiving age-dependent coverages such as lifetime waiver of premiums, conversion notifications, and disability credit reports for hour bank plans, . Maintains and updates a variety of spreadsheets such as beneficiary information.

Client Accounting (all plan types)

Provides a variety of accounting administrative support services to health benefit plans clients for hour bank, non-hour and special fund plans to ensure timely and accurate production of monthly bank reconciliations, and synoptics, financial statements, billings and accounts payable by:

- compiling daily/weekly deposits and postdated payments, recording bank interest and service charges, and balancing and reconciling bank statements;

- posting pre-paid remittances and negative adjustments;

- identifying, investigating and resolving variances, and making adjusting entries;

- identifying shortages in plan funding and seeking trustee approval for top up;

- producing monthly accruals used by internal specialists to determine plan cost per member, funding parameters and other usage statistics;

- producing monthly/quarterly income statements and balance sheets or profit/loss statements depending on the plan type, and updating worksheets for trustee review for expense control purposes;

- processing and balancing plan shortage payments received through electronic funds transfers;

- preparing invoices for administration fees and plan expense such as EFT and courier charges, life insurance and other premium payments for insurance carriers;

- producing and distributing payments via cheque and electronic transactions;

- posting payments to general ledgers and making adjusting entries;

- updating supplier interest rate changes for invoicing purposes;

- calculating and filing GST rebates and payments.

Provides information to auditors conducting year end audits of a variety of financial transactions including responding to general inquiries and information requests, providing explanations concerning journal entries or other transactions and obtaining additional files and records on request.

Special Funds Administration (all plan types)

Administers unique or specialized funds established by client groups to address industry requirements such as divers’ medical exam reimbursements and substance abuse rehabilitation specific to the needs of individual industry or occupational groups, including receiving applications from members for benefits, determining eligibility and processing payments and reimbursements.

Administers health spending reimbursement accounts, checks eligibility and processes monthly medical expense claims.

Plan Amendments (all plan types)

Maintains and updates health benefit plan system data sources when plan changes are made by trustees including:

- receiving information from plan trustees and/or senior plan consultants on a regular basis on benefit plan changes including rules, rates, effective dates, eligibility, templated and customized letters and reports, and terms of coverage;

- analyzing and identifying where data sources require updating;

- depending on the plan type, entering plan changes via spreadsheet or through direct system coding to update policy sheets, annual salary changes, standard reports and other benefit plan data;

- testing system changes prior to release and ensuring all reconciliation and balancing features are accurate and operational;

- updating carrier payment amounts;

- creating new remittance forms where employer dollar amounts are new or changing;

- ensuring internal departments receive benefit plan changes impacting their area of operation;

- advising website administrators where website updates are required;

- tracking changes in business rules for assigned plans, updating plan booklets and related plan materials, and distributing letters and updated plan information to members.

Sets up new groups and employers in a variety of technology platforms by coding new health benefit plan system data in accordance with the participation agreement negotiated by senior plan specialists and trustees such as eligibility schedules, rates, billing account information, member data, invoicing and report types.

Pension Plan Administration

Administers one or more assigned pension plans to ensure clients, members, trustees, custodians and other stakeholders receive contracted services in accordance with established standards of service quality, accuracy and turnaround time by:

- maintaining current information on employee pension benefit status through secure employer websites;

- responding to direct member inquiries on plan benefits, rules and procedures, distributing appropriate forms and instructions for refunds, withdrawals, terminations and other options, and following up to ensure timely and accurate completion and return;

- processing member requests for plan refunds depending on eligibility and entitlements;

- using a variety of online pension calculation tools, determining pension benefits, options and alternatives for member consideration including those with tax and retirement income planning vehicles or referring those with complex technical considerations to internal or external actuarial resources;

- preparing and distributing retirement information packages, ensuring all documentation is returned and confirmed, processing electronic funds transfer request for direct deposit, preparing confirmation letters and updating system entries;

- updating existing spreadsheets, calculating tax payable on payment amounts and determining net amounts;

- releasing monthly automated funds transfers for pensioners and/or processing payments through third party provider, posting related system entries and balancing to T4A listings;

- producing and distributing annual pension statements;

- ensuring all work is peer reviewed prior to member distribution and payment.

Customer, Client and Member Service (all plan types)

Responds to inquiries, including those of a confidential or sensitive nature, from members, unions, trustees, custodians, beneficiaries, employers and providers received through phone, email, personal visit and fax contact on a diverse range of plan administration procedures, issues and concerns such as eligibility, claims rejections, inaccurate or incomplete reporting of hours or client information, missing identification or drug cards, direct deposit set-up and expiry of self-pay coverage. Applies a variety of customer service tools and techniques to clarify client issues, diffuse hostility, ensure open communication and promote customer well-being.

Using the intermediate features of Excel, revises spreadsheets to improve ease and efficiency of use and to enhance appearance through the application of borders, formatting, linking cells and creating automatic updates for synoptics, life insurance and long-term disability tracking. Using the intermediate features of Word including character, paragraph and page formatting, ClipArt, page borders and mail merges, customizes outgoing member letters, file labels and tables.

Logs all member, client, trustee and custodian interactions

TMSS Scheduler

Performs the primary TMSS Scheduler role for the Administration Services Department by:

- ensuring employees clock in and clock out as required;

- keying all missed or exception entries and adjustments including daily leave request; coordinates the vacation bidding process and administers vacation changes and Family Responsibility Leave balances by maintaining and updating applicable spreadsheets;

- opening and processing weekly leave requests and updating department attendance reports;

- responding to all inquiries, demonstrating use of the system on a one-on-one basis to new users, and liaising with Human Resources as required to resolve more complex issues and adjustments.

General Team and Department Support (all plan types)

Verifies member eligibility for all benefit plans at the request of internal staff members involved in claims adjudication, client accounting and pension administration, provides clarification on specific features of plans under administration such as interpretation of bereavement leave benefits and explains plan procedures in unclear cases.

Maintains a variety of manual and automated department files and records

Provides informal on the job demonstrations of work methods and procedures to new employees.

Performs other assigned duties related to the provision of benefit plan administration and/or clerical support which do not affect the rating of the job.

Qualifications:

• High school graduation or equivalent
• Completion of Group Insurance Certificate program offered through ADVOCIS (Financial Advisors Association of Canada) (37 hours) OR EQUIVALENT (applies to Hour Bank/Non-Hour Benefit Plan job bundles)

OR

• Completion of The Canadian Pension and Benefits Institute Pension Plan Administration Certificate Level 1 (Introduction to Pension Plans 36 hours) through Humber College (36 hours) OR EQUIVALENT (applies to Pension Administration job bundle)
• Completion of Accounting Level 1 (FMGT 1100) (36 hours) OR EQUIVALENT
• Completion of Intermediate Word (18 hours)
• Completion of Intermediate Excel (18 hours)
• Demonstrated proficiency in Intermediate Word and Intermediate Excel
• A minimum of one year previous related experience in a customer service- oriented position such as inbound call centre agent or dealing with customer inquiries over the phone and in person.
• Ability to effectively communicate both verbally and in writing
• Demonstrated numerical comprehension
• Demonstrated attention to detail