Health care manager serp_jobs.h1.location_city

STRS Ohio, STRS

The State Teachers Retirement System of Ohio (STRS Ohio) is seeking a Health Care Enrollment Coordinator to join its Member Benefits / Health Care Production Operations team.

Established in 1920 and serving Ohio’s educators, STRS Ohio is one of the nation’s largest retirement systems, serving over 500,000 active, inactive, and retired public-school teachers, and university faculty members, managing approximately $96.9 billion as of June 30, 2024, in assets and paying more than $7 billion in benefits annually.

STRS Ohio provides a competitive pay, and a comprehensive benefits package including on-site parking, educational assistance, subsidized medical insurance, fully paid dental and life insurance, vacation and sick leave, retirement benefits and on-site fitness center. At STRS Ohio, you can experience rewarding work in a professional, business casual work environment. We welcome, celebrate, and promote respect for everyone. We are continually seeking bright and talented individuals to join our team.

Compensation :

$27.45 / hr. or commensurate with education and experience

Work Schedule :

8 : 00am-5 : 00pm Monday through Friday (Onsite)

General Summary :

Under the direction of the manager, Health Care (HC) Production Operations, research and resolve cross-functional health care issues, with a collaborative approach toward enrollment, eligibility and claims. Coordinate health care enrollment issue resolution for benefit recipients and enrollees. Process enrollment related workflows and daily, weekly and monthly health care reports.

Summary of Responsibilities :

Process health care enrollment and eligibility in compliance with State Teachers Retirement System of Ohio (STRS Ohio) Administrative Rules and Centers for Medicare and Medicaid Services (CMS) regulations and ensure accurate enrollee billing.

Collaboratively resolve member coverage issues as result of Medicare enrollment, acceptance into the Medicare Advantage Plan, Part D plan. Prioritize immediate access coverage issues.

Discuss high level benefits, coverage and claims processing with enrollees and plan administrators.

Work with internal and external parties including plan administrators, Medicare intermediaries and others to ensure each health care plan enrollee’s issue is handled appropriately.

Utilize detailed knowledge of enrollment eligibility, 834 files (files shared between STRS Ohio and the plan administrator), pension processing system and vendor processing procedures to ensure the efficient, accurate enrollment and issue resolution.

Cultivate and maintain a detailed knowledge of STRS Ohio health care benefits, rationale for program changes.

Confer with department managers on complex escalated issues requiring thorough review and policy consideration.

The above list of duties is intended to describe the general nature and level of work performed by persons assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the persons so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of associates under supervision.

Summary of Qualifications :

High school diploma or equivalent is required.

Bachelor’s degree in a related field preferred.

Two to four years relevant work experience required, four or more years relevant work experience preferred.

Comprehensive knowledge of Medicare enrollment guidelines, benefits and programs required.

Experience explaining medical and pharmacy benefits to enrollees preferred.

Interpersonal skills necessary to deal effectively and courteously with internal and external contacts required.

Excellent organizational skills and a high degree of accuracy and attention to detail required.

Equal Employment Opportunity Employer Statement

State Teachers Retirement System of Ohio (STRS) is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees on the basis of race, color, religion, gender, gender identity or expression, national origin (ancestry), military status, disability, age, genetic information, sexual orientation, or caregiver status, in making employment-related decisions about an individual.

ADA Statement

STRS Ohio is committed to ensuring access, inclusion, and reasonable accommodations across all its services, activities, programs, and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Posting Drug-Free Workplace Statement

The State Teachers Retirement System of Ohio (STRS Ohio) is a drug-free workplace. The use of recreational marijuana and non-medical cannabis is strictly prohibited.

Pre-Employment Drug Testing

All final candidates tentatively selected for employment will be required to undergo a urinalysis drug screening prior to appointment. This screening includes testing for illegal substances, including marijuana. A positive test result will disqualify the applicant from employment unless valid medical documentation is provided for legally prescribed medications or a physician’s recommendation for medical marijuana.

Pre-Employment Background Investigation

The final candidate selected for this position will be subject to a criminal background check. STRS Ohio will conduct an individualized assessment of any prior criminal convictions before making a determination regarding employment eligibility.