JOB TITLE: DIRECTOR, HEALTH INSURANCE OFFICE, PSERS

JOB CODE: 05341

DEFINITION: This is highly responsible professional and specialized administrative work in managing all aspects of the health insurance program for the Public School Employees' Retirement System (PSERS).

The employee in this job is responsible for planning, developing, coordinating, implementing, and administering the post-employment health care programs, including the provisions of health insurance and prescription drug options, dental insurance, premium assistance benefits, and a healthy lifestyle incentive program. Work includes the responsibility for independently administering self-insured medical and drug plans for the benefit of retirees. Work also involves the administration of Medicare Part D prescription plans with federal government oversight. Work includes developing and implementing departmental health care insurance program policies, procedures, and strategic plans; formulating and proposing benefit levels, premium rates, and reserves for the complex self-funded programs; establishing and implementing operational procedures for the processing of self-funded plan benefits and the adjudication of claims; creating and approving strategies for marketing of health care insurance plans; developing the program administration budget; overseeing multiple third party contracts to assist in related efforts; and negotiating and managing third party contracts including enforcing contract performance goals and standards. An important aspect of this work involves advising PSERS’ Board on health care insurance matters. Supervision is exercised over subordinate administrative staff. Work is performed with considerable independence within the framework of Board policies and is reviewed through conferences, reports, and the effectiveness of results.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.):

• Directs the administration of the PSERS’ post-employment health care program.

• Establishes and implements strategic operational plans, policies, and guidelines related to the administration of PSERS’ Health Options Program (HOP).

• Determines and proposes local market competitive benefit levels, prescription formularies, premium rates, marketing strategies, financial reserves, and related policies for self-funded health benefit plans.

• Writes and implements policies, guidelines, and procedures for the processing of self-funded plan benefits; the adjudication of claims; and the marketing of the health care plans.

• Administers several Medicare Part D prescription plans and related contracted compliance services with the U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Services.

• Establishes and continually evaluates program goals, objectives, effectiveness measures, and improvement initiatives.

• Oversees the research of member movement into and away from plans as well as options within the plans to determine the type and levels of future retiree health plans to be offered.

• Evaluates the individual health insurance market in Pennsylvania and other states where PSERS’ retirees reside to determine feasibility of plans and to develop recommendations for plans based on competitiveness.

• Analyzes financial data and actuarial proposals for setting member contribution rates.

• Ensures the Health Options and the Premium Assistance Programs are in compliance with all federal contracts and regulations.

• Prepares and monitors the annual budget for the overall program administration.

• Negotiates contracts and financial arrangements with insurance carriers and benefit providers, including third party administrators.

• Prepares vendor requests for proposals, develops the evaluation criteria, participates in the technical evaluation and ranking of bids, recommends selection of carriers, conducts best and final offer negotiations, and implements benefit plans.

• Represents PSERS before the Retirement Board’s Appeals Committee, at administrative hearings, and various speaking engagements.

• Serves as a voting member on PSERS’ Executive Staff Review Committee to analyze, provide input, and help the committee to make determinations for all health care options and premium assistance related member appeals.

• Directs the preparation of correspondence or reports for the signature of the Executive Director on unusual or complex health care insurance related problems or in response to letters sent to the Governor, legislators, retirement associations, or members of the system.

• Oversees the design, development, and delivery of health insurance communications to current and future participants.

• Promotes effective communications and public relations with retiree groups, unions, school districts, carriers, the legislature, and board members.

• Performs the full range of supervisory duties.

• The employee in this job may participate in the performance of subordinates’ work consistent with operational or organizational requirements.

• Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of health care delivery systems.

• Knowledge of the administration of self-funded health benefit plans.

• Knowledge of the principles and practices of contract negotiation and administration.

• Knowledge of the principles and practices of budget administration.

• Knowledge of strategic and operational planning techniques.

• Knowledge of the principles and methods used to conduct formal presentations.

• Knowledge of the use and functionality of Microsoft Office suite software.

• Knowledge of effective customer service techniques.

• Ability to analyze and interpret written information, such as rules, regulations, policies, procedures, and legislation.

• Ability to analyze and interpret data in the form of tables, graphs, and charts.

• Ability to communicate effectively orally.

• Ability to communicate effectively in writing.

• Ability to establish and maintain effective working relationships.

FULL PERFORMANCE KNOWLEDGES, SKILLS, AND ABILITIES: (NOTE: These are expected of an employee performing the work of this job at the full performance level. These may not be evaluated by the State Civil Service Commission or used for Civil Service examination purposes and are not position-specific performance standards.)

• Knowledge of the principles and practices of supervision.

• Ability to evaluate programs and identify problems, devise solutions, and develop consensus among competing interests.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities):

• Six years of professional experience in the design, implementation, and administration of a self-funded group health insurance benefit program that includes two years of experience in a supervisory or consultative capacity involving health insurance benefits experience, and a bachelor's degree;

or

• Certification as a Certified Employee Benefits Specialist and five years of professional experience in the design, implementation, and administration of a self-funded group health insurance benefit program that includes two years of experience in a supervisory or consultative capacity involving health insurance benefits experience, and a bachelor's degree;

or

• An equivalent combination of experience or training that includes two years of experience in a supervisory or consultative capacity involving health insurance benefits experience.