Legal Operations Attorney

2 months ago

New York, United States 1199SEIU Benefit and Pension Funds Full time

Who we are:

The 1199SEIU Funds are among the strongest and largest labor-management funds in the United States. Our employees are committed to caring for the healthcare workers who care for others. The Funds provides defined pension benefits and employee welfare benefits (health, education, training and childcare) to unionized healthcare workers (members) through 20 jointly administered employee benefit plans governed by the Employee Retirement Income Security Act (ERISA).


The Legal Operations Division is a critical component to managing the law-adjacent operational services of the Funds. We are seeking a Legal Operations Attorney to support the functions of the Legal Operations Division related to plan benefit payments for Union members. Reporting to the Legal Operations Director, the Legal Operations Attorney will lead, and support services related to disputed benefits, driving them to successful completion by coordinating with legal and business stakeholders. We offer exceptional benefits and working conditions, competitive non-profit compensation, and an opportunity to work with a great team


Responsibilities


Administrative Appeals

  • Assist in the administration of member challenges to plan benefit denials in compliance with the Employee Retirement Income Security Act (ERISA). This work involves collaborating with cross-functional departments across the family of Funds (health, pension, education, training and childcare), the Appeals Department, and the General Counsel’s Office to ensure accuracy, accessibility, and compliance in written appeals materials, including determination letters to members explaining benefits, and case summaries presented to Board members.
  • Work with the General Counsel for preparation of second-level appeal presentations.


US DOL inquiry responses

  • Respond to the U.S. Department of Labor's (DOL) Employee Benefits Security Administration (EBSA) Benefits Advisors representing members as they navigate their Fund benefits or challenge benefit denials. This work is like responding to administrative appeals, described above.
  • Respond to EBSA Benefits Advisors as they investigate billing grievances by healthcare providers, either on behalf of members, or pursuant to the No Surprises Act. This work involves collaborating with the Provider Relations Department and the General Counsel’s Office.


Lien Enforcements

  • Provide support to the Worker’s Compensation and Liens Department to assist in the research, negotiation and settlement of the Funds’ liens against members’ third-party recoveries (e.g. “no-fault” awards, tort settlements, and workers compensation claims settlements) including attending hearings in court or at the Workers Compensation board.
  • Liaise with other attorneys, insurance carriers, health care providers, General Counsel and various Fund departments to resolve complex and escalated liens matters.


Additional Responsibilities

  • Coordinate the Funds’ class member claim submissions for class action lawsuit settlements
  • Assist with applicable departmental policy updates
  • Proactively identify benefit administration process issues encountered during the above duties, and encourage or suggest solutions for improvement
  • Perform additional duties and projects as assigned by management


Qualifications


  • Juris Doctor Degree required; admission to practice in New York State preferred.
  • Minimum of three (3) years legal experience or health insurance experience preferred.
  • Knowledge of laws, regulations, and decisions governing employee benefits, Workers Compensation, No-Fault, and not-for-profit organizations including ERISA, Internal Revenue Code and CMS rules, health care payor administration, Taft-Hartley plans and multi-employer plan specific issues preferred.
  • Excellent writing and legal reasoning skills are essential, as is the ability to work as part of a team and interact with operational staff, General Counsel and outside counsel.
  • Ability to work with and communicate effectively with staff, Trustees, and other professionals.
  • Good judgment and able to take on responsibility independently.

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