This is a Position Based Test conducted in accordance with Civil Service Commission Rule 111A. 

Specific information regarding this recruitment process are listed below:

• Application Opening: Thursday, October 3, 2024
• Application Deadline: Thursday, October 31, 2024
• Compensation Range: $87,230 - $106,002
• Recruitment ID: PBT-1210-151744

This is a Position-Based Test conducted in accordance with CSC Rule 111A.

The 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.

Under general supervision, performs professional benefits work for the Health Service System's Membership and Medical Claims Divisions and performs related duties as required. Explains the City's health, dental, vision, prescription, disability plans, Flexible Spending Accounts, and Dependent Day Care and Medical Reimbursement programs. Essential functions include: providing written and oral benefits information; advising and counseling members, retirees, and surviving spouses or domestic partners on available benefits; analyzing and resolving member claim problems; processing complex claims; initiating, compiling, calculating, and processing adjustments and manual payments; interacting frequently with staff and providing training as needed; consulting with plan providers and department representatives; researching, reconciling, and resolving employee benefits and claims issues; and conducting workshops and giving presentations.

May exercise technical and functional supervision over technical/clerical staff.

Typical tasks include:

1. Provides written and oral information to members, retirees, medical providers and other interested parties regarding active and retired employee health and welfare benefit programs.

2. Advises and counsels members, retirees, and surviving spouses or domestic partners on available benefits, pursuant to rules and regulations of the Health Service System and federal and state laws.

3. Analyzes and resolves member claim problems.

4. Processes complex claims, and disburses benefits for the Health Service System.

5. Initiates, compiles, calculates, and processes adjustments to member records, premium receivables and medical claim histories.

6. Researches, reconciles, and resolves various member problems related to membership, eligibility, premiums, and medical claims accounts.

7. Interacts frequently and provides training when necessary to subordinate staff engaged in membership enrollments, terminations, accounts receivable, collection, and medical claims adjudication.

8. Consults with plan providers and department representatives regarding the member's status.

9. Conducts workshops for potential retirees and new hires regarding benefits, plans, costs, etc. and assist with the completion of required paperwork. Gives presentations to departmental orientations.

10. Processes and collects manual payments from employees on leave of absence, under COBRA and retirees.

11. Perform word processing and data entry/retrieval/

12. Perform work in a standard office environment.

13. Performs related duties and responsibilities as assigned.

Minimum Qualifications

Education:
Possession of a baccalaureate degree from an accredited college or university

Experience:
One (1) year of verifiable experience administering benefit programs including: initiating membership records, calculating benefit premiums and processing enrollment applications; processing, researching and/or adjusting benefit claims or problems and updating data

Substitution: Additional experience as described above 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.

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.

All work experience, education, training and other information substantiating how you meet the minimum qualifications must be included on your application by the filing deadline. Information submitted after the filing deadline will not be considered in determining whether you meet the minimum qualifications.

Resumes will not be accepted in lieu of a completed City and County of San Francisco application.

Applications completed improperly may be cause for ineligibility, disqualification or may lead to lower scores.

Selection Procedures:
After application submission, candidates deemed qualified must complete all subsequent steps to advance in this selection process, which includes the following:

• Minimum Qualifications Supplemental Questionnaire [MQSQ] - Candidates will be required to complete a MQSQ, which will be emailed within two weeks of receiving applications, as part of the employment application. This MQSQ is designed to obtain specific information regarding an applicant's experience in relation to the Minimum Qualifications (MQ) for this position. The MQSQ will be used to evaluate if the applicant possesses the required minimum qualifications.
• Supplemental Questionnaire [SQ] (100% weight) - Candidates who meet the Minimum Qualifications and complete the MQSQ will be sent a SQ via email to complete and return within a certain timeframe. The SQ has been designed to measure knowledge, skills and/or abilities in job-related areas. The SQ will be rated and scored. All relevant experience, education and/or training must be on the SQ in order to be reviewed in the rating process.

Note: Candidates must achieve a passing score on the selection components described above in order to move forward in the selection process.

Eligible List/Score Report:
A confidential eligible list of applicant names that have passed the civil service examination process will be created, and used for certification purposes only. An examination score report will be established, so applicants can view the ranks, final scores and number of eligible candidates. Applicant information, including names of applicants on the eligible list, shall not be made public unless required by law. However, an eligible list shall be made available for public inspection, upon request, once the eligible list is exhausted or expired and referrals resolved. The eligible list/score report resulting from this civil service examination process is subject to change after adoption (e.g., as a result of appeals), as directed by the Human Resources Director or the Civil Service Commission.

The duration of the eligible list resulting from this examination process will be 6 months, and may be extended with the approval of the Human Resources Director.

To find Departments which use this classification, please see https://sfdhr.org/sites/default/files/documents/Forms-Documents/Position-Counts-by-Job-Codes-and-Department-FY-2023-24.pdf.

Certification: The certification rule for the eligible list resulting from this examination will be Rule of Ten (10). The hiring department may administer additional position-specific selection procedures prior to making final hiring decisions.

Terms of Announcement and Appeal Rights:
Applicants must be guided solely by the provisions of this announcement, including requirements, time periods and other particulars, except when superseded by federal, state or local laws, rules or regulations. Clerical errors may be corrected by the posting the correction on the Department of Human Resources website at https://careers.sf.gov/.

The terms of this announcement may be appealed under Civil Service Rule 111A.35.1. The standard for the review of such appeals is ‘abuse of discretion’ or ‘no rational basis’ for establishing the position description, the minimum qualifications and/or the certification rule. Appeals must include a written statement of the item(s) being contested and the specific reason(s) why the cited item(s) constitute(s) abuse of discretion by the Human Resources Director. Appeals must be submitted directly to the Executive Officer of the Civil Service Commission within five business days of the announcement issuance date.

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

HOW TO APPLY
Applications for City and County of San Francisco jobs are only accepted through an online process. Visit https://careers.sf.gov/ and begin the application process.

• Select the “I’m Interested,” or “Apply Now” button and follow instructions on the screen

Applicants may be contacted by email about this recruitment and, therefore, it is their responsibility to ensure that their registered email address is accurate and kept up-to-date. Also, applicants must ensure that email from CCSF is not blocked on their computer by a spam filter. To prevent blocking, applicants should set up their email to accept CCSF mail from the following addresses (@sfgov.org, @sfdpw.org, @sfport.com, @flysfo.com, @sfwater.org, @sfdph.org, @asianart.org, @sfmta.com, @sfpl.org, @dcyf.org, @first5sf.org, @famsf.org, @ccsf.edu, @smartalerts.info, and @smartrecruiters.com).

Applicants will receive a confirmation email that their online application has been received in
response to every announcement for which they file. Applicants should retain this confirmation email for their records. Failure to receive this email means that the online application was not submitted or received.

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

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.