Insurance Specialist

*** This job opportunity is not in the classified service and is not covered by the West Virginia Division of Personnel merit system. ***

Join our team at PEIA! This position will assist members, providers and the general public via telephone, walk-in or correspondence concerning benefits and claims in the administration of the Public Employees Insurance Agency Benefits Program. This position will perform a variety of basic customer service work by answering inquiries, resolving complaints and explaining benefits, rules, regulations and agency policies. Must be knowledgeable about all benefits administered by the agency. May travel throughout the state. This position will perform work as required.

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• Answers less complex written and verbal inquiries from members, retirees, providers, attorneys, Third Party Administrators, state and local government agencies, and the general public by explaining rules, regulations and agency policies.
• Composes and types correspondence.
• Enters data into computer system.
• Resolves problem claims by interacting with claimants, payroll clerks, providers and insurance companies.
• Assists in researching appeals.
• Documents telephone calls.
• May travel throughout the state explaining benefit programs.
• May prepare monthly billings and update premiums for agencies.

Knowledge, Skills and Abilities

• Knowledge of the Public Employees Insurance Agency Benefit Program and the West Virginia Children Health Insurance Program rules, regulations and policies.
• Knowledge of Third Party Administrators policies, systems and operations.
• Knowledge of English grammar use and composition.
• Ability to explain benefit programs to members, providers and the general public.
• Ability to interpret rules, regulations and policies.
• Ability to type accurately.
• Ability to deal with sensitive issues in an orderly and controlled manner.
• Ability to establish and maintain good working relationships with members, providers, attorneys and the general public.
• Ability to communicate effectively, both orally and in writing.

Training:
Graduation from a standard high school or the equivalent.

Experience:
Two years of full-time or equivalent part-time paid experience in a clerical capacity.