The work involves responsibility for participating in the administration of a local employee health insurance program. This employee performs a variety of tasks associated with the administration of a local employee health insurance program by resolving claim situations with agency carriers, implementing practices to correct agency problems with insurance programs, and solving questions concerning eligibility. Work assignments follow standard operating guidelines and carrier rules and regulations. General supervision is exercised over a small number of clerical personnel. Does related work as required.




Leads and participates in assisting enrollees in the preparation and submission of claims by reviewing forms and transactions for conformity to standard procedures and by reviewing computer listings and manual records pertaining to enrollment and/or deductions to check accuracy by contacting insurance carriers, enrollees, physicians, supervisory personnel and other related contacts to gather information to explain or solve errors.

Assigns and supervises the daily activities of subordinate personnel in the work of the employee benefits department; provides training and instruction to subordinates in the preparation and processing of applicable forms, documents and records.

Provides education and instruction to employees regarding plan benefits, limitations, policies, procedures, penalties, etc.

Determines eligibility for benefits and assists in the completion of applications and documents for enrollment.

Maintains employee enrollment records including coverage changes and other changes that relate to the employee benefit package.

Processes leave of absence information, including letters of explanation, plan requirements, invoicing for appropriate premiums following negotiated contract settlements and federal leave policies.

Reconciles monthly/quarterly/annual reports as required.

Coordinates department activities with state and federal agencies, insurance companies, and other agencies as necessary.

Verifies eligibility for enrollment in the health insurance program for every new employee.

Makes additions, deletions and changes to enrollment; notifies employees not covered by the local program regarding privileges of converting to alternate health insurance coverage.

Assists in the interpretation and implementation of rules and regulations for application to and enrollment in benefit programs such as New York State retirement, COBRA rules and regulation and the Family Medical Leave Act.

Coordinates benefit programs and provides payroll support for benefits including health, dental, vision, tuition reimbursement, 403(b) program, savings bond, retirement contributions, credit union deductions, flexible spending, et al.




Good knowledge of rules, regulations and eligibility criteria of the employee health insurance program.

Good knowledge of local, state and federal rules and regulations regarding benefits, including COBRA


Good knowledge of health insurance rates, types of coverage, deductions, credits and billing procedures.

Good knowledge of rules, regulations and procedures regarding submission of major medical claims.

Good knowledge of employee benefits terminology and procedures involved in processing benefit claims.

Working knowledge of the principles and practices of supervision.





Ability to interpret written, narrative and tabular material regarding benefit programs.

Ability to communicate both orally and in writing with emphasis on explaining the provisions of the insurance program to employees and enrollees.

Ability to identify significant factors in claims and eligibility problems and to reach logical conclusions based on analysis of these factors.

Ability to supervise a small number of staff involved in the clerical processing of health, dental and other employee benefits.







One (1) year of permanent competitive class status as an Assistant Employee Insurance Representative; or,

One (1) year of permanent competitive class status in a third level clerical title; or,

Two (2) years of permanent competitive class status in a second level clerical title.



Open Competitive:


Two (2) years of work experience, or its part time equivalent, in the processing of health insurance claims and transactions, which must have included responsibility for the verification of claimant's eligibility for health insurance coverage and the review of records to ensure the validity of claims.


11/2014 Revised