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Health and Welfare Claims Manager
2 months ago
The Teamsters Joint Council No. 83 of Virginia Health & Welfare and Pension Funds (“Funds”), located in Richmond, VA, are currently seeking a Health and Welfare Claims Manager (“Manager”) capable of supervising the day-to-day activities of the Claims Department to ensure efficient workflow and accuracy.
The ideal candidate will be highly motivated and independent, with strong organizational, project management and analytical skills, strong knowledge of health and welfare benefits and claims processing, as well as a strong leader with experience in supervising a collectively bargained staff. This position reports directly to the Executive Director in areas concerning health and welfare benefits. This position requires the Claims Manager to be in the office located in Richmond, VA full time (this is not a remote position).
The Teamsters Joint Council No. 83 of Virginia Health & Welfare and Pension Funds consist of two (2) Taft-Hartley, benefit plans. The Health and Welfare Funds provide health, prescription, vision and dental benefits to eligible participants and dependents, and the Pension Funds provide retirement benefits to eligible participants. The Funds provide welfare benefits to approximately 11,000 participants and beneficiaries.
Key Responsibilities
Specific responsibilities include, but are not limited to, the following:
- Supervises claims procedures, policies, and daily operations, as well as activities pertaining to claims, COBRA and Coordination of Benefits, to ensure optimal customer service and adherence to claims processes, deadlines, and procedures.
- Establishes training and workflows for the Claims Department, prioritizes work assignments, evaluates employee performance, and develops staff. Resolves staff issues, works with the Executive Director to recommend hiring or termination decisions, and administers disciplinary action, as required.
- Implements programs and enforces collective bargaining agreement, policies, and procedures. Monitors attendance, and approves timesheets and time-off requests, in order to ensure compliance with collective bargaining agreement.
- Supervises staff, including one-on-one and team meetings, to review procedures, processes and share knowledge related to system, customer service, and claims processing.
- Ensures all medical claims processing activities are in compliance with all plan rules and applicable government regulations and requirements and consults with outside professionals on compliance matters as needed.
- Ensures appropriate staffing levels are maintained, including hiring of claims staff as needed.
- Oversees development and training of all Claims Department staff to maintain current knowledge/skills and ensure professional growth.
- Communicates with participants, professional advisors, governmental agencies, employers, union officials, and Trustees.
- Coordinates and works with all relevant service providers as needed to ensure accurate and timely benefit payments.
- Creates and evaluates staff productivity reports and ensures that staff provides quality customer service both by phone and in person.
- Investigates claims issues and assists with resolving escalations in a quick and thorough manner, identifying the root cause of issues.
- Works with the Executive Director to ensure compliance with service-level agreements, contracts, COBRA, HIPAA as well as other regulatory issues, and acts as a subject matter expert.
- Acts as Project Manager, as needed.
Requirements
The ideal candidate will meet the following requirements:
- Work Experience: Minimum of five (5) years of experience in Benefits Claims Processing is required, including a minimum of three (3) years of supervisory experience. Prior experience with self-funded plans and/or in Taft-Hartley or collective bargaining environment is preferred.
- Educational Background: Bachelor’s degree, or equivalent work experience is required. Advanced degree is a plus.
Special Skills or Credentials: The selected candidate will have a solid knowledge of claims administration and processing of health and welfare benefits, as well as of governmental/legislative regulations governing such plans. Preferred skills include: familiarity with ICD-10 codes; medical terminology certification; dental claims processing experience; and knowledge of Basys (system vendor). The ideal candidate will be a professional with demonstrated leadership skills, a proven “hands-on” supervisory style, excellent judgment, and strong work ethic. Qualified candidates will possess exceptional interpersonal and communication skills, strong project management skills, strong analytical skills and be highly organized. Candidates must be able to multi-task and prioritize effectively in order to meet deadlines, and have a thorough knowledge of, and appreciation for, the regulatory and political environment. Proficiency with current MS Office suite and experience with benefits administration systems is required.
To Apply
The Funds offer a competitive salary and a comprehensive benefits package. The Funds are an affirmative action employer and encourage applications from all qualified candidates regardless of gender, race, ethnicity, age, sexual orientation, marital status, religion, or disability.
To apply, please send your resume and salary requirements to atcresumes@segalco.com. Please include job reference code 0724TJ83HWCMLI in the subject line or with your application.
