City : Burnaby

Category : Health Insurance

Industry : Insurance

Employer : Pacific Blue Cross

We are recruiting for Health Benefits Administrator role for our Benefits team within D.A. Townley! This is a temporary (up to 12 months) role and will require working from office as well as home (hybrid).

With over $1 billion in assets under administration, D.A. Townley is the largest third party employee benefits administrator in western Canada. D.A. Townley provides group benefit programs to over 1,000 corporate and union clients in BC and the rest of Canada, and coverage for 100,000 employees/members and dependents.

Since 1962, consistency, stability, and exceptional service have been hallmarks of D.A. Townley throughout its successful operation in the British Columbian market. Commitment to this philosophy has maintained D.A. Townley’s excellent reputation and continued steady growth. D.A. Townley was acquired by Pacific Blue Cross in 2015 enabling them to further strengthen their service to their clients.

Job Summary

Under the general supervision of the Team Leader and on an assigned basis, performs Health Benefits Representative 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 D.A. Townley 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 Bank Plans Administration

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

Hybrid Benefit Plans Administration

Provides a wide range of administrative services to D.A. Townley clients, members, trustees, custodians and unions for benefit plans with a range of features which may include hour bank, non-hour bank and unique plan design components.

All Health Benefit Representatives perform year end tax remittance duties, respond 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. Communicates internally with all staff members to verify plan eligibility, provide clarification on specific features of plans and explain plan procedures.

Job Duties

On an assigned basis, performs Health Benefits Representative 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 D.A. Townley 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 the hour bank system, tracking hours and determining eligibility for benefits coverage based on each plan’s business rules and policy requirements;

• 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, flagging pending claims or plan usage where funds are insufficient and providing monthly totals to Client Accounting;

• 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 from Client Accounting.

Non-Hour Benefit Bank Plans Administration

• Provides a wide range of administrative services to D.A. Townley clients, members, employers and unions for non-hour bank 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 the administration system and accessing the provincial MSP system 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;

• balancing and reconciling monthly MSP premium billings with bank statements for individual and group plans and making adjusting entries to correct rate or billing variances;

• setting up new plans on the provincial MSP system;

• receiving requests from Claims Administration to investigate status of self pay 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;

• producing accounts payable invoices, accounts receivable reports and carrier reports at month end;

• updating rate files and policy sheets annually to reflect changes in benefits;

• troubleshooting routine issues with employer websites such as accessing locked employee information screens, changing email addresses on request and explaining website procedures for entering employee data; escalates to PBC’s IaTS specialists where required.

Hybrid Benefit Plans Administration

• Provides a wide range of administrative services to D.A. Townley clients, members, trustees, custodians and unions for benefit plans with a range of features which may include hour bank, non-hour bank and unique plan design components by:

• keying employer remittance reports to track employee data such as hours worked, coverage type, union dues and contributions made to established plan funds through electronic uploading or manual entry;

• enrolling new or reinstated employees and determining eligibility for benefits coverage based on each region’s business rules, policy requirements, and layoff and extension parameters;

• loading remittance data from the hour bank system into specific plan systems such as the Non-Destructive Testing group, analyzing and correcting error edit codes produced through the loading process and reloading data;

• identifying and correcting coverage duplicates;

• identifying and processing self-payment refunds;

• generating month end reports including self pays and regional status reports for employer and trustee review;

• advising members of delinquent bond submissions.

• Administers unique or specialized funds established by client groups to address industry requirements including training/education funds and retiree benefits, including any or all of the following duties:

• pre-approving employee requests for reimbursement upon successful completion of industry-required courses through assessment of eligibility including hours worked, completion of pre-requisite courses, timing and other established eligibility criteria;
• processing requests for reimbursement upon course completion;

• preparing and submitting accounts payable invoices to Quality Control Council of Canada for QCC-offered courses and workshops;

• maintaining claims paid and claims pending files and records;

• recovering payments made to members for course completion where continuing employment hours are insufficient or where members have left the industry, and referring unsuccessful recovery attempts to a collection agency;

• reporting to trustees on course popularity, fund usages, requirements for additional trainers and other activities relating to administering educational funds;

• determining eligibility for retiree benefits based on contributions made and length of service and advising qualifying retirees of options and benefits.

Year End Functions (all plan types)

• Generates T4As to ensure taxable benefits such as MSP, life insurance, accidental death and dismemberment, life insurance and retiree benefits have been included in final calculations.

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 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.

• Maintains liaison between members, trustees and underwriters where claims issues such as rejections or early termination of wage loss benefits require facilitation. Compiles claims-related information and escalates to trustees or internal benefit plan specialists for further action.

• Logs all member, client, trustee and custodian interactions.

• Tracks changes in business rules for assigned plans and provides input into the updating of plan booklets and related plan materials for distribution to members.

General Team and Department Support (all plan types)

• Verifies member eligibility for all benefit plans at the request of internal staff member 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.

• On an occasional relief basis or where accelerations in work volumes occur, may key billings and remittances normally processed by other internal staff members into online systems.

• On an occasional relief basis, performs all functions of the Client Experience Representative and staffs the D.A. Townley reception area.

• 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
• Completion of Accounting Level 1 (FMGT 1100) (36 hours) OR EQUIVALENT
• Demonstrated proficiency in Basic Word and Basic Excel
• A minimum of 1 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

While we thank all applicants for their interest, only shortlisted candidates will be contacted.

We strive to create a workplace where everyone feels valued and employees feel empowered to freely participate and contribute regardless of race, ethnicity, gender, sexual orientation, religion, ability, education level, parental status, or socioeconomic status. PBC is an equal opportunity employer and welcomes applications from all qualified candidates.

To request an accommodation in completing this application, pre-employment testing, interviewing or otherwise participating in the employee selection process, please direct your inquiries to careers@pac.bluecross.ca.