Operation’s initiates participant enrollment and processes changes to enrollment records. Within Operations there are two subsections, Enrollment and Eligibility and Member Services.  Enrollment and Eligibility has the responsibility of determining eligibility for participants as well as validating and processing subsequent changes to enrollment records. An estimated 35,000 enrollments and/or enrollment changes are processed per plan year. The Member Services section of Operations provides assistance to plan participants by responding to phone calls and email inquiries providing information on plan benefits and eligibility.

PEBP’s Information Technology section develops and maintains department information systems and applications, including the development of new systems and/or enhancement of existing computer systems. In addition, the IT section performs computer hardware and software installation and maintenance and trouble-shooting PC problems.

The Accounting section is responsible for the administration of PEBP’s financial data and providing accurate and timely information to plan stakeholders. Accounting has the responsibility to ensure premium statements for individuals and group accounts are accurate and timely produced. This section is also responsible for rate setting, budgetary planning and instituting internal/external controls to ensure the plan operates on a financially sound basis.

The Quality Control section oversees claims processed by the third party administrator, United Medical Resources, Inc. (UMR) (formerly Fiserv Health Plan Administrators). This section is also responsible for proposals of contracted services and administers vendor contracts to ensure all requirements are met. Additionally, Quality Control is responsible for PEBP’s internal education and training programs, handling of complaints and is the 2nd level appeals process.

The Public Information section is responsible for communicating plan benefits to all participants. This section is responsible for publishing quarterly newsletters, updating the PEBP website, developing annual open enrollment documents, presenting plan changes during open enrollment meetings, facilitating annual focus group meetings, developing and presenting statewide benefits orientation classes for new employees and retirees and representing PEBP at various speaking engagements.