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MANAGER, STUDENT HEALTH INSURANCE
Job Title: MANAGER, STUDENT HEALTH INSURANCE
Job Code: 1318
FLSA: E
Job Level: 12
Revised Date: 07/01/2018
Job Family: JF 28
Occupational Summary
Manage the Duke Student Medical Insurance Plan (SMIP), which includes management of the enrollment and waiver processes, providing customer service & communications, and monitoring financial & accounting processes.
Work Performed
Manage the insurance enrollment and waiver process during open enrollment periods each academic year.
Determine population of students eligible for participation in the SMIP; monitor and update for changes to this population based on status changes.
Extract eligible student data from PeopleSoft and upload to the insurance provider website on a regular basis. Monitor international students holding F1/J1 visas to ensure they are automatically enrolled in the SMIP.
Review and compare eligibility data from Duke and the insurance provider on a regular basis to ensure compatibility; research and resolve any discrepancies.
Research and rectify insufficient address information to ensure students receive insurance enrollment cards.
Manage enrollment of special groups of students. Provide customer service and communications to Duke students, parents, and departments as related to the SMIP enrollment & waiver process, benefit details, premium rates, and other information.
Maintain continued communication with students who have not provided a decision during open enrollment periods.
Provide necessary forms and/or communications to students who have enrollment needs outside of the normal open enrollment periods.
Arrange for marketing materials/communications on an as needed basis.
Provide schools/departments with updated lists of students with no insurance decision.
Respond, on a timely basis, to calls/questions/e-mails from students, parents, and departments regarding questions related to the insurance requirement and the enrollment/waiver process.
Monitor and update the Student Health insurance website as needed.
Handle other matters and questions related to default enrollment, website access, waiver denials, late waiver requests, and dependent coverage.
Monitor financial and accounting processes related to insurance charges and service indicators on student accounts.
Maintain insurance service indicator data on each student account in PeopleSoft to ensure it matches decision data.
As waivers or terminations are approved, ensure that charges are appropriately adjusted in student accounts.
Assist with reconciliation of enrollment data to charges posted on student accounts (i.e. matching charge data to enrollment data from the insurance provider).
Prepare summary financial and/or enrollment reports on an as needed basis.
Manage incoming inquiries related to patient billing, physician coding, and insurance coverage/benefits.
Explain policies and procedures, and facilitate charge corrections related to incorrect billing.
Gather necessary documentation to support proper handling of inquiries and complaints.
Communicate with insurance carriers and outside vendors regarding clinical information requested to resolve issues relating to coverage and payment.
Act as technical resource to operational management and staff on the appropriate interpretation of insurance benefits and payments.
Communicate specific insurance benefits and patient liability to patients and providers.
Ensure proper authorization or prior approval has been obtained to ensure accurate billing for requested referrals.
Offer pretreatment pricing prior to scheduling outside specialty appointments.
Direct and coordinate various personnel functions.
Perform yearly performance appraisals for direct reports.
Perform necessary counseling or corrective action related to direct reports performance.
Approve vacation request and ensure proper staffing related to clinic need.
Conduct meetings with staff and ensure compliance with established practices.
Complete biweekly payroll ensuring accuracy.
Perform other related duties incidental to the work described herein.
Required Qualifications at this Level
Education/Training
Work generally requires a bachelor's degree in Accounting, Management, or a related business field. Work requires a general knowledge of insurance plans and customer service.
Experience
Work generally requires two years of customer service-related experience. At least two years supervisory experience is preferred.
OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE
Skills
Must be proficient in using various types of software such as; Access, Excel, IDX, Lotus Notes, Point and Click, SISS/People Soft, Word, as well as software specific to insurance companies. Must be able to communicate university insurance requirements to domestic and international students and to interpret insurance policies and regulations to students, parents and health care providers, university, sponsoring programs and government officials. Must be able to work with university and insurance company files, extracts, etc.
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
