See ES Benefits Technician.

Provides training to staff on insurance benefits program elements;

Interprets and explains applicable state and federal laws, regulations and policies to employers and clients participating in the program;

Reviews casework of lower level Benefits Specialists to ensure accuracy and conformance to laws, regulations, policies and procedures;

Conducts research and analysis of claim history and supporting documentation in order to identify whether or not claims were adjudicated correctly;

Provides senior level technical assistance to internal and external claimant/customer;

Provides staff with expertise and assistance in the most complex claim issues;

Consults with agency management on claimant/customer relations issues; recommends changes to agency procedures to enhance access to agency services;

Resolves claimant/customer problems by identifying the issues, determining procedural steps necessary to bring resolution, working with program staff to implement resolution, and communicating results to the claimant/customer;

Reviews policy and provides procedural clarification and consultation; performs complex case review and problem resolution; provides statewide policy and procedure development input and consultation;

Develops, schedules, and conducts orientation programs for new employees on department regulations and procedures, casework principles and methods, caseload management, community resources, individual and group behavior, and interviewing skills;

Designs, creates, and updates lesson plans, student handbooks, assessments, handouts, trainer guides, and other materials for instructor led training; develops and secures program training materials, maintains training library; keeps informed of current training practices and materials;

Participates and/or facilitates subject-matter-expert groups to identify training needs;
Advises and assists program management in planning and conducting local training programs; develops recommendations for management on training needs, assessments, and issues;

Develops, schedules, and conducts training on new policies and procedures and new state regulations or requirements for program services;

Conducts quality assurance audits; reviews casework to ensure accuracy and conformance to laws, regulations, policies, and procedures;

Interviews claimant/customer, collect and analyzes data to detect deficient controls, fraud or non-compliance with laws, regulations and policies;

Reviews responses to quality assurance audits, as required by legal, statutory or legislative requirements; reviews and approves corrective action plans;

Prepares extensive reports of audit findings and recommendations; provides audit results and corrective action needed to employer;

Tests, analyzes and evaluates accounting system to verify integrity of data; performs and coordinates advanced statistical and non-statistical data sampling.

Provides claimant/customer and employers with technical assistance understanding their rights and responsibilities under the program;

Educates employers and their representatives to promote voluntary compliance with laws and policies;

Monitors wage reports for errors or rejected reports and provides technical assistance to employers to resolve;

Researches and resolves unpaid premiums resulting from unfiled employer reports or errored reports;

Estimates premium liability for non-reporters;

Researches and review escalated claimant/customer benefit complaints and issues; review appeals for validity; determines if data gathering and verification techniques were documented;

Serves as liaison with Employment Security Department, Attorney’s General Office and Office of Administrative Hearings ensuring compliance with directives is consistent with interpretation of WACs and RCWs;

Participates in appeal audits and provides recommendations to monitor compliance and identify opportunities for improvements;

Oversees preparation of appeal summaries, correspondence and documents to track and trend data; assist in preparation of narratives, graphs and flowcharts for presentations and audits;

Implements policy, process and claim decisions received from Office of Administrative Hearings;

Represents the agency in actions and decisions upheld by the adjudicative process;

Performs the duties of the lower levels in the series;

Performs other duties as required.

Knowledge of: insurance benefits service programs, applicable state and federal laws, regulations and policies, principles, problems, and practices of insurance benefits program administration; principles of individual and group behavior, social behavior, social and economic conditions, and their effects upon individuals; office procedures and practices; leading subordinate employees.

Ability to: make independent conclusions and decisions; evaluate and recommend changes to insurance benefits program management; work cooperatively with staff, members of the public and with co-workers; practice tact, courtesy and discretion; accurately document, listen, observe, communicate, confront and engage in problem solving and conflict resolution; convey interest and concern to claimant/customer requesting information or assistance with problems related to insurance benefits programs and services; express ideas clearly; direct and assist others in interpretation and analysis of data; lead and train staff.

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Persons legally authorized to work in the U.S. under federal law, including Deferred Action for Childhood Arrivals recipients, are eligible for employment unless prohibited by other state or federal law.

One year as a ES Benefits Specialist 2.

OR

A Bachelor’s degree in a health or social science, public administration or a related field and two years of experience examining and/or processing loan applications, medical insurance or rehabilitation claims, insurance claims, collection of insurance premiums, tax collection or providing staff support in financial eligibility determination.

OR

A Master’s degree in a health or social science, public administration or a related field and one year of experience examining and/or processing loan applications, medical insurance or rehabilitation claims, insurance claims, collection of insurance premiums, tax collection or providing staff support in financial eligibility determination.

OR

A combination of education and relevant experience.

OR

One year of experience equivalent to the ES Benefits Specialist 2 with another state that administers insurance benefits programs.