Under general supervision, administers one or more benefit programs. Consults with and advises employees on eligibility for insurance, hospitalization, and other benefits, amounts of coverage, and claims procedures. Maintains benefit records and prepares documents necessary for implementing benefit coverage. May supervise one or more benefits clerks. Under FLSA, incumbents in this position are nonexempt.
Provide a full range of day-to-day prescription drug plan support services to customers, vendors and pharmacies for university-enrolled employees/retirees/dependents. Resolve weekly eligibility files and manage annual open enrollment eligibility file coding changes, file loads and ID card issuance. Maintain a confidential database of case contacts. Respond to urgent and routine customer concerns on plan design, including coverage, exclusions, copay/co-insurance, and quantity limits. Advise customers, physicians and pharmacies on process and procedures for prior authorization, appeals, and various pharmaceutical management programs developed by the Benefits Administration Office Pharmacy Team. Complete basic claim reviews for accuracy to plan design. Coordinate with PBM vendor to resolve urgent and routine customer claim and billing problems that occur at retail and mail order pharmacies. May involve counseling and education of customers on options and plan design.
Individual works directly under the supervision of the Drug Plan Manager, with access and guidance from two on-site clinical pharmacists for consultation and interpretation of plan design. Individual coordinates resolution of issues with university Shared Services staff, PBM vendor client services staff, pharmacies and customers. Individual prepares job aids and training materials for university Shared Services staff, PBM vendor and pharmacy call center staff. Individual monitors and instructs communication staff on website design and content, and contributes to various plan communications.
Minimum Bachelor's degree with 5 years' experience in human resource activities, extensive Microsoft Office proficiency, excellent communication skills, and ability to work in a high-production environment with confidential and technical information. Individual will be provided with and must complete a Certified Pharmacy Technician program for the State of Michigan. Considerable cross-training with existing staff will occur.
The University of Michigan is an equal opportunity/affirmative action employer.