Benefits Representative

2 weeks ago

Burnaby, Canada Pacific Blue Cross Full time

We are recruiting for Health Benefits Administrator role for our Benefits team within D.A. Townley This is a temporary (up to 12 months) role and will require working from office as well as home (hybrid).

With over $1 billion in assets under administration, D.A. Townley is the largest third party employee benefits administrator in western Canada. D.A. Townley provides group benefit programs to over 1,000 corporate and union clients in BC and the rest of Canada, and coverage for 100,000 employees/members and dependents.

Since 1962, consistency, stability, and exceptional service have been hallmarks of D.A. Townley throughout its successful operation in the British Columbian market. Commitment to this philosophy has maintained D.A. Townley’s excellent reputation and continued steady growth. D.A. Townley was acquired by Pacific Blue Cross in 2015 enabling them to further strengthen their service to their clients.

**Job Summary**

Under the general supervision of the Team Leader and on an assigned basis, performs Health Benefits Representative functions in one, some or all of the following areas of operation:
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**Hour Bank Benefit Plans Administration**

Provides a wide range of administrative services to D.A. Townley clients, members, trustees, custodians and unions for hour bank plans designed to provide continuing benefit plans coverage based on accumulated hours worked for single or multiple employers on a month by month basis.

***

**Non-Hour Benefit Bank Plans Administration**

Provides a wide range of administrative services to D.A. Townley clients, members, employers and unions for non-hour bank plans designed to provide benefit plans coverage for salaried groups with continuing employment.

**_ _**

**Hybrid Benefit Plans Administration**

Provides a wide range of administrative services to D.A. Townley clients, members, trustees, custodians and unions for benefit plans with a range of features which may include hour bank, non-hour bank and unique plan design components.

***

**Job Duties**
- Systems Maintenance and Updating of Drug Records, Pricing, Shortages and Monthly Drug Load_

1. Updates and maintains PBC’s drug formulary housed in the online data management system (ACES) to ensure pharmacy drug claims adjudicated and/or accessed by multiple internal departments and external stakeholders pay out accurately in real time by:
b. updating drug data via multiple and complex spreadsheets, and uploading and maintaining daily drug shortage information in ACES;
c. receiving and responding to requests from internal and external contacts including providers and members to aid in resolving claims payment or claim denials relating to drug changes, updates or group plan coverage;
d. conducting drug load procedures following monthly system upload performed by external vendors to identify and manually correct drug load discrepancies and variances caused by interfacing and conflicting entries;

e. updating and maintaining the Drug Identification Number (DIN) record to reflect additions, revisions or deletions of drugs referenced in group or individual plan contracts.

f. maintaining and updating the setup of new drugs and service code groupings by coding, adding, editing, enforcing and terminating various fields in ACES to ensure compatibility with eligibility requirements for coverage by a wide range of internal PBC and external users such as Drug Exception Team, Claims Solutions, those processing drug claims and Pharmacy Pay Direct;
g. updating member ACES PharmaCare registrations.

2. Researches drugs purchased outside of Canada using a variety of online drug products databases on request from a wide range of internal and external contacts such as Customer Experience, Out of Country Examining team and pharmacists to identify the closest equivalent Canadian drug. Selects the appropriate external response from a repository of templated letters based on the nature of the inquiry.

3. Researches compounded and off label drugs to determine eligibility for coverage based on matching compounded and off label information to approved equivalents. Follows up with pharmacists to validate specific compounding formulas. Investigates time frames for shortages of commercial products giving rise to the need for compounding.

4. Confirms prescribing and dispensing permissions to determine eligibility of specific types of drugs being dispensed and the circumstances under which they are being prescribed.

**Extended Health Claims Review**

6. On referral from a wide range of internal contacts or through direct contact with service providers, members, Select Plan and other plan administrators, analyzes a variety of requests and inquiries concerning extended health claims, pre-authorizations, adjustments, overpayments and other situations relating to extended health benefits, eligibilities and entitlements which require more in-depth research by:
b. responding directly to phone inquiries from members, providers and p

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