Benefits Technician (job code 1209) San Francisco Health Service System

The San Francisco Health Service System (SFHSS) provides health benefits for SFHSS members - employees and retirees - of the City and County of San Francisco, the San Francisco Unified School District. San Francisco City College and the San Francisco Superior Court. and their dependents. Staff must know and administer benefits for 136,000 lives with over 29 benefit plans from 10 different vendors. These benefits plans include Medicare and Non-Medicare medical, dental, vision benefits, as well as life insurance, long-term disability benefits, flexible spending accounts for health and dependent care and COBRA.  Delivery system transformation aimed at achieving better health outcomes requires care models that integrate a broad array of services to address physical, behavioral, and social needs. The San Francisco Health Service System (SFHSS)  recognizes that Race and the Social Determinants of Health (SDoH) – conditions in which people are born, live, learn, work, play, worship, and age – play a significant role in well-being. SFHSS will lead with equity to support our membership in accessing the care they need when they need it, regardless of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

Temporary Exempt position

• Application Opening –March 21, 2025
• Application Deadline – Apply immediately.  Application will be open until April 4, 2025 by 11:59 p.m. The portal will close at 12:00 a.m. on April 5, 2025, and applications will no longer be accepted. 

Under immediate supervision, the Benefits Technician performs technical and clerical work in employee benefits for the City's Health Service System and performs related duties as required. Member interaction includes in-person and telephone contact. Essential functions include: providing support services to analysts in processing claims and benefit entitlements; providing general information to City employees regarding benefits; communicating with employees and representatives from various departments and outside agencies; researching and reconciling records and accounts; making adjustments and performing database maintenance; reviewing, completing and processing member and/or dependent plan enrollment; performing various calculations; completing standard form letters; and maintaining reports, logs and records.

Typical tasks include:

1.Provides support services to analysts in processing claims and benefit entitlements.

2.Provides general information to City employees regarding health and dental benefits.

3.Researches records and accounts for prior membership, premium history, account discrepancies, requested information, payment history, overpayments, underpayments, and adjustments in database.

4.Makes adjustments, and creates, updates, inputs, and maintains information in the computer software files or in the database.

5.Reviews, completes, and processes a variety of membership eligibility forms.

6.Conducts research on claims to determine appropriate rates to use for payment and refers claims needing further attention to an analyst or supervisor.

7.Performs various calculations to support the determination of health services benefits.

8.Communicates with employees, dependents, human resources, and payroll personnel within citywide departments, representatives from outside agencies, medical practitioners, lawyers, and other professionals.

9.Responds to routine vendor and claimant inquires on unpaid medical invoices and enrollment eligibility.

10.Completes standard form letters, and maintains reports, logs, and records.

11.Performs related duties and responsibilities as assigned.

Education:

Completion of two (2) years college-level course work

Substitution:

Verifiable clerical or technical experience administering employee benefits programs including: researching records, claims adjudication, database maintenance, reviewing forms, performing calculations, and responding to general inquiries may be substituted for the required education on a year-for-year basis. Thirty (30) semester units/forty-five (45) quarter units equal one year of experience.

Desirable Qualifications:

The stated desirable qualifications may be considered at the end of the selection process when candidates are referred for hiring:

•Knowledge of health plan administration
•Strong writing skills
•Strong Microsoft Word and Excel skills
•Ability to understand and apply rules and regulations

Verification of Education and Experience:

Applicants may be required to submit verification of qualifying education and experience at any point during the recruitment and selection process. If education verification is required, information on how to verify education requirements, including verifying foreign education credits or degree equivalency, can be found at https://sfdhr.org/how-verify-education-requirements.

Note: Falsifying one’s education, training, or work experience or attempted deception on the application may result in disqualification for this and future job opportunities with the City and County of San Francisco.

If you have any questions regarding this recruitment please contact the analyst, Lauren Rowe at [email protected].

Additional Information Regarding Employment with the City and County of San Francisco:

• Information About the Hiring Process
• Conviction History
• Employee Benefits Overview  
• Equal Employment Opportunity 
• Disaster Service Worker
• ADA Accommodation
• Veterans Preference
• Seniority Credit in Promotional Exams
• Right to Work
• Copies of Application Documents
• Diversity Statement

The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.