State of Maryland

An Employee Benefits Specialist IV is the full performance level of professional HR work in the Department of Budget and Management (DBM). Employees in this classification function as technical experts in the State Personnel Management System (SPMS) in the area of health benefits, including specialized enrollment, claims issue resolution and counseling work related to the application and interpretation of laws, rules, regulations and policies governing the State’s Employee and Retiree Health and Welfare Benefits Program, which is under the jurisdiction of the Department of Budget and Management, Office of Personnel Services and Benefits.  Employees in this classification perform enrollment-related job duties, as well as fulfill a customer service role. Employees in this classification are proficient in enrollment-related matters and customer service-related inquiries.  Employees in this classification do not supervise other positions.

Employees in this classification receive general supervision from a designated administrator. The work requires employees to answer frequent telephone calls and to exercise tact and diplomacy in responding to inquiries and respond calmly to heated discussions in regard to health benefits issues. The work may require travel throughout the State of Maryland. Employees are required to obtain and maintain certification in SPMS policies and procedures and in the functionality of the Statewide Personnel System (SPS) in order to demonstrate knowledge, understanding and skill in the administration of the State’s Employee and Retiree Health and Welfare Benefits Program.

Positions in this classification are evaluated by using the classification job evaluation methodology. The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

The Employee Benefits Specialist I, Employee Benefits Specialist II, Employee Benefits Specialist III, and Employee Benefits Specialist IV are differentiated on the basis of degree of supervisory control exercised by the supervisor over these employees. The Employee Benefits Specialist I learns and begins to perform duties under close supervision. The Employee Benefits Specialist II performs duties under close supervision. The Employee Benefits Specialist III performs duties under moderate supervision. The Employee Benefits Specialist IV performs the full range of duties and responsibilities under general supervision.

Reviews enrollment events or applications to ensure all required information and documentation is included and the proper coverage levels have been selected;

Rejects enrollment events or applications that do not contain required information and returns to agencies or individuals (as appropriate) for corrections or modifications;

Enters data from enrollment events or applications into automated systems within specific time frames;

Prepares letters to participants to request official documentation to support application statements in addition to other correspondence to respond to written inquiries;

Prepares and reviews notification of termination events to remove participants from the health benefits database systems;

Enters, retrieves, updates and resolves tickets in MOJO (or similar help desk) support system within applicable timeframes;

Advises program participants of available health benefits options in order to provide assistance with making informed health care decisions;

Interprets and applies health benefits laws, rules, regulations and policies; Communicates with Health Benefits Vendors to resolve participant claim coverage issues;

Researches participant records using computer databases, other agency and control agency information systems and identifies discrepancies in the payment of deductions resulting from events such as agency transfer or military active duty;

Counsels participants and retirees in one-on-one settings and on the telephone and performs the required follow-up to provide requested information;

Prepares correspondence to participants, Agency Benefits Coordinators and Health Benefits vendors in response to information requests and determinations;

Completes necessary documents to ensure expeditious and effective initiation of payments from retirees;

Prepares letters to participants, outside parties, vendors, etc. in response to various inquiries regarding the health plans;

Reads and interprets Account Detail section of Benefits Administration System in order to accurately assist members with account information;

Reads and navigates the online payment system (Velocity or similar system) to assist end-users in password resets and making/scheduling payments;

Maintains participant automated files by recording file maintenance transactions on data input documents;

Prepares for and makes presentations and participates in training sessions for groups of employees, employee representatives, and Agency Benefits Coordinators to explain health benefits procedures, restrictions and requirements;

Conducts pre-retirement seminars for participants at various locations throughout the State;

Conducts training on benefits-related systems;

Informs separated participants about options to temporarily continue health insurance coverage by application for Consolidated Omnibus Budget Reconciliation Act (COBRA);

Performs a variety of report-related tasks, including working vendor error reports, age reports, evidence of insurability report, EGWP/PDP reports, etc.;

Handles 60-day exception requests;

Processes administrative corrections in accordance with applicable benefits laws/regulations/procedures;

Performs tasks related to 61st-day closure of benefits events in the SPS;

Performs other related duties.

Knowledge of office procedures, business English, spelling, grammar and arithmetic;

Ability to apply Health Benefits Program plans, rules, regulations, and policies;

Ability to apply retirement-related State laws/regulations/policies as these relate to health benefits administration;

Ability to interpret and apply State Central Payroll regulations;

Ability to provide exceptional customer service;

Ability to identify and correct errors regarding information provided by participants, State agencies, Health Benefits Vendors and others;

Ability to navigate proficiently in a variety of system applications, such as: MOJO or similar help desk ticketing systems, Benefits Administration System, Workday and Velocity or similar online payment system;

Ability to accurately analyze and address the issues presented by participants and other interested parties;

Ability to communicate effectively;

Ability to make presentations before small and large groups and to present information in a clear and concise manner;

Ability to establish and maintain effective working relationships with co-workers, division staff, other government officials and the general public;

Ability to exercise tact and discretion in dealing with State employees, co-workers, the general public, and government officials;

Ability to accurately view and interpret accounting/payment systems information in order to assist callers.

Experience: Five years of experience responding to inquiries, calculating program eligibility, counseling and advising persons concerning health benefits.

Notes:

1. Candidates may substitute the possession of a Bachelor’s degree from an accredited college and university and three years of experience responding to inquiries, calculating program eligibility, counseling and advising persons concerning health benefits for the required experience.

2. Candidates may substitute the possession of a Master’s degree from an accredited college or university in Business Management, Business Administration, Human Resources or Public Administration for four years of the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Human Resources classifications or Human Resources specialty codes if the work includes benefits-related experience on a year-for-year basis for the required experience

1. Employees in this classification are required to obtain certification in State Personnel Management System policies and procedures and in the functionality of the Statewide Personnel System from the Office of Personnel Services and Benefits, DBM within six months from the time of the appointment to the position. Employees also are required to obtain recertification every six months thereafter.

2. Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may be required to possess a motor vehicle operator’s license valid in the State of Maryland.

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System.  All positions in this classification are Skilled Service positions.  Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is not assigned to a bargaining unit, as indicated by the designation of S (Supervisor), M (Manager), T (Agency Head), U (Board or Commission Member), W (Student), X (Used by Agency or Excluded by Executive Order), or Z (Confidential).  As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded from collective bargaining.  Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.