Insurance Specialist

Colorado State University
Fort Collins, Colorado, United States
25 Mar 2018
End of advertisement period
22 Apr 2018
Contract Type
Full Time

Description of Work Unit

The CSU Health Network at Colorado State University provides a full range of cost effective, on-campus, mental health and primary care medical services, referral for community specialty care and comprehensive health education and prevention services’ programming. Services such as physical therapy, dentistry and optometry, are available. The CSU Health Network is active in creating a healthy campus environment to support learning and success. For more information about the CSU Health Network at Colorado State University, see

The Insurance Department provides a health insurance program to Colorado State University students, in an efficient and professional manner by designing and implementing a comprehensive health plan at an affordable rate; to provide support services related to the program, i.e., determining eligibility, enrollment/billing of premiums, adjustment/calculation/claims payment of charges on the self-funded portion of the program; give assistance to insured students with the claims process and closely work with the claims administrator; assist and educate students who are enrolled in the plan in understanding how to use the insurance. This unit enforces the mandatory insurance enrollment requirements for all CSU students and manages the waiver and appeal process including; educating students at large about the importance of health insurance for all students. evaluate and render waiver decisions regarding other insurance plans and closely work with the waiver administrator. This unit administers the RamCare program which includes enrollment, communication to students, billing of program fee and processing claims payments Additionally, this unit manages any necessary follow up with other CSU departments, outside vendors, outside provider offices and insurance companies to accomplish these goals.

Position Summary

The Insurance Specialist provides excellent customer service and guidance to all CSU students in navigating their health insurance needs, regardless of their enrollment in the CSU insurance program or an outside insurance plan. Staff members are responsible for the Student Health Insurance Plan (SHIP), the RamCare Program and CSU’s Health Insurance Requirement. Specific duties related to SHIP and RamCare as follows: billing of premiums, managing enrollment and cancelations, paying claims and customer service. Staff members regularly process claims in our electronic health record system (PyraMed) and an Access database for services provided under both the Student Health plan and RamCare. These tasks often require follow up with other departments within CSU Health Network as well as outside vendors to ensure accurate processing/payment.

Staff members assist international students with their policies and help determine whether or not their plan meets the requirements necessary for approval. Staff members are responsible for completion of the international waiver process by evaluating and rendering independent decisions regarding comparability of various group and individual policies to the requirements established by CSU and the Board of Governors. Staff also assist domestic students with the online waiver process. Staff members work with the third party waiver company to accomplish the cancelling or waiving students from the CSU insurance program while using multiple CSU systems (Aires Web, Banner, PyraMed). Staff members are expected to use research, resources and independent judgment based on experience and training to make decisions in their daily work. The INTO program’s student enrollment in the Student Insurance program adds a monthly option that makes the complexity of determining eligibility, claims payment and tracking becomes much more difficult. All staff members are trained and able to back up at least one other staff member in the department to ensure continuity of workflow, including backing up the referral coordinator.

CSU offers full benefits which include Medical, Dental, Vision, Life Insurance, Flexible Spending Accounts, retirement programs and more. The University’s Commitment to Campus benefits program offers a wide range of programs, discounts and special benefits available to eligible faculty and staff. For more detailed information about CSU benefits, Colorado State University, and Fort Collins, you can visit,, and

Minimum Qualifications

To be considered for this position applicants must have:
Three full-time years (36 months) of medical and/ or health insurance billing experience, which must include at least one year of direct customer service.



Preferred Qualifications

Highly sought applicants will have many of the following:


  • One or more years of experience processing health insurance claims
  • One or more years of experience as a work lead or supervisor

Exceptional performance in the following competencies:

  • Verbal and written communication skills
  • Interpersonal relations skills
  • Teamwork skills
  • Conflict management skills
  • Math and analytical skills
  • Organizational and follow-through skills
  • Attention to detail and accuracy

Demonstrated Knowledge of the following:

  • Medical terminology/physiology and anatomy
  • Medical treatments
  • Use of MS Office including Access, Excel and Word
  • Electronic health record

Essential Job Duties

Job Duty Category Waiver Process Duty/Responsibility

  • Manage the institutional requirement for all full time students to carry health insurance
  • Review plans submitted for waiver for international students and make a determination independently
  • Work with waiver vendor to assist domestic students through the online waiver process
  • Assist with and coordinate appeals for students who did not complete the waiver process in the waiver period. This involves the ability to professionally interact with the student, parent, waiver company and/or insurance company to make sure all needed information is obtained and provide feedback to students and parents on results as well as research and provide other available options

Percentage Of Time 25% Job Duty Category Claims Payment and Processing for SHIP and RamCare Duty/Responsibility

  • Research medical records of insured students including CPT and ICD-9 medical coding, diagnosis codes, physician notes and SHIP or RamCare program parameters in evaluating if charges for medical care obtained at the CSU Health Network (CSUHN) are payable under the self-funded portion of the plan
  • Enter payable charges into a separate database (Access) and also process through the EHR (electronic health record), PyraMed, to clear charges from CSUHN receivables. If determined to be non-payable, send charges on to the third party payer or bill to the student account
  • Balance daily reports between PyraMed and Access systems

Percentage Of Time 35% Job Duty Category Eligibility and Customer Service Duty/Responsibility

  • Determine individual insurance needs and whether or not each student meets the eligibility requirements for enrollment in the plan; utilize Pyramed, Aries, Banner, and Access programs for information
  • Provide customer service for the insurance program by addressing walk-in traffic, phone calls or emails
  • Know and follow the legal requirements for appropriate medical release process and acquisition under medical records laws and HIPAA
  • Follow appropriate documented in-house procedures as well as using the TPA’s referral system

Percentage Of Time 20% Job Duty Category Enrollment, Cancellations and Billing Duty/Responsibility

  • Maintain and update enrollment rosters of insured students after validating that required eligibility standards have been met; this process involves research and entry into multiple University systems and interactions with other campus departments including international programs and the graduate program, as well as the registrar’s office
  • Assist students in enrollment or cancellation of policy as appropriate
  • Conduct manual billing of insurance premiums and other applicable fees as necessary
  • Receive notifications of changes to student status and determine how this change affects their insurance eligibility
  • Assess premiums, fees and other charges accordingly
  • Balance insurance figures across all systems
  • Participate in regular enrollment audits

Percentage Of Time 20%

Special Instructions to Applicants


  • Clearly document job duties you have performed that relate to minimum qualifications, preferred qualifications, and essential job duties in the Work Experience section on the application. Human Resources must be able to evaluate your experience based on this information.
  • Clearly outline dates of employment and hours worked per week for each employment experience listed in the Work Experience section of the Application so that Human Resources can calculate full-time work experience.
  • The APPLICATION is the only document that will be utilized to determine if minimum qualifications, as outlined in the job posting, have been met. The Application is considered to be the legal document on file; resumes will not be reviewed for minimum qualification requirements.


  • If an Application is considered “Incomplete”, the Application will be removed from consideration for the position.
    • An Application is incomplete if no current/ previous employment is included in the Work Experience section of the Application.
    • An Application is incomplete if “see resume” (or something similar) is noted, or previous employment does not contain job duties for every position in the Work Experience section of the Application.
    • Positions requiring a degree or if using education as a substitution for work experience (eg: Associate or Bachelor’s) transcripts are required in order to verify receipt of the required degree or coursework. If official or unofficial transcripts are not supplied at the time of application, the Application is incomplete.


  • When a resume is listed as a required document, it may be used in the comparative analysis/ evaluation process to determine the candidates that most closely meet the qualifications of the position. This process occurs after an application has passed the minimum qualifications screening.
  • Resumes will not be accepted in place of a completed application; however, some positions may still require a resume as a component for complete application materials.
    **Please see the Required Documents section of the posting.


  • The selection process for State Classified positions may include an exam(s), which requires candidates to physically appear (at the CSU campus in Fort Collins, CO) at the candidates’ own expense.
  • All status updates for this position will be sent via email from In addition to your Inbox, remember to check the Deleted and Junk folders for these important communications.
  • Pertinent updates to your Application status can be obtained by logging into your application account at


  • Please check the Help link online at for assistance on your application or for answers to Frequently Asked Questions.
  • All other inquiries should be directed to the Colorado State University Human Resources Office

EEO Statement

Colorado State University is committed to providing an environment that is free from discrimination and harassment based on race, age, creed, color, religion, national origin or ancestry, sex, gender, disability, veteran status, genetic information, sexual orientation, gender identity or expression, or pregnancy and will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Colorado State University is an equal opportunity/equal access/affirmative action employer fully committed to achieving a diverse workforce and complies with all Federal and Colorado State laws, regulations, and executive orders regarding non-discrimination and affirmative action. The Office of Equal Opportunity is located in 101 Student Services.

The Title IX Coordinator is the Executive Director of the Office of Support and Safety Assessment, 123 Student Services Building, Fort Collins, CO 80523 -2026, (970) 491-7407.

The Section 504 and ADA Coordinator is the Associate Vice President for Human Capital, Office of Equal Opportunity, 101 Student Services Building, Fort Collins, CO 80523-0160, (970) 491-5836.

Background Check Policy Statement

Colorado State University (CSU) strives to provide a safe study, work, and living environment for its faculty, staff, volunteers and students. To support this environment and comply with applicable laws and regulations, CSU conducts background checks. The type of background check conducted varies by position and can include, but is not limited to, criminal (felony and misdemeanor) history, sex offender registry, motor vehicle history, financial history, and/or education verification. Background checks will be conducted when required by law or contract and when, in the discretion of the university, it is reasonable and prudent to do so.