Responsible for assisting the Benefits Manager in the administration of welfare plan benefits to include health, dental and flexible spending account plans. Monitors claims quality and recommends adjustments as needed. Handles escalated claims issues and related provider/member interactions. Evaluates current benefit plans and processes, then recommends new and/or enhanced programs and processes that will provide strong competitive positioning and increase efficiency for the company. Works with minimal supervision and is responsible to make an established range of decisions, escalating to manager when necessary and updates manager on a regular basis.

What you will do:

• Manages claims division to ensure that welfare plan benefit administration complies with relevant legislation including Department of Labor requirements.
• Coordinates, studies and interprets reports related to claim cost containment and recommends changes as appropriate.
• Works with manager to implement changes to processes, workflow and plan documents to assure compliance with federal regulations.
• Collaborates with systems support to develop and execute project plans that ensure our systems are maintained and operate with current releases.
• Performs workflow analysis and monitors plan expenses to determine process/plan improvements for claims processing that maintain or increase plan efficiency and cost effectiveness.
• Monitors claim billing in accordance with generally accepted standards of medical practice.
• Handles problem cases and complaints. Has oral and written communications with active and retired associates and outside medical professionals.
• Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality, and protection of personal information, including, but not limited to, personal health information and personally identifiable information.
• Performs other duties as assigned.
• Complies with all policies and standards.
• Provides direction to and development of associates through daily coaching, the administration of the Performance Management Model, and the creation and implementation of development plans. Recruits, hires, trains and develops staff.

• Bachelor's Degree (Required)
• Proven experience in the administration of health plan medical claim processing and claim coding (Required) and
• Proven experience working independently to make decisions and demonstrate initiative. Demonstrated analytical skills to include identifying, defining and resolving problems and collecting or interpreting data to establish facts and draw valid conclusions and provide creative solutions to complex problems. (Required) and
• Demonstrated experience leading and motivating teams including providing direction, coaching and effective feedback to team members. (Required) and
• Proven experience adapting and demonstrating flexibility associated with changes to policies/procedures. (Required)
• Familiarity with PPO Plan network pricing models and medical plan design. (Preferred)
• Proficient in Federal Regulations such as ERISA, Cafeteria Plans, COBRA, and HIPAA and Medicare Coordination of Benefits.
• Proven success managing projects from initial research/planning stage to implementation.
• Demonstrated complete discretion in handling confidential and sensitive materials.
• Proven superior verbal and written communication skills with ability to convey information, verbally and in writing, to internal and external customers in a clear, accurate, focused and concise manner. Demonstrated ability to document procedures and activities in a manner that is understandable to others and prepared using a prescribed format. Verbal and written communications are to conform to proper rules of punctuation, grammar, diction and style.
• Demonstrated ability to effectively collaborate and communicate with all levels of employees and management.
• Proven ability to read, analyze and apply statistical information to financially related information and data.
• Demonstrated strong attention to detail with excellent organization skills. Must cite examples of organization and time management/methods used to manage or prioritize workload demands.
• Proficient in word-processing, spreadsheet and database applications.
• Certified Employee Benefits Specialist (CEBS)-IFEBP within 180 Days (Required)

Work Setting/Position Demands:

• Works in an office setting and remains in a stationary position for long periods of time while working at a desk, on a computer or with other standard office equipment, or while in meetings.
• Requires the ability to verbally communicate and exchange accurate information to customers and associates on a regular basis.
• Requires visual acuity to read and interpret a variety of correspondence, procedures, reports and forms via paper and electronic documents, visual inspection involving small defects; small parts, and/or operation of machinery (including inspection); using measurement devices continuously. Visual acuity is required to determine accuracy, neatness, and thoroughness of work assigned.
• Requires the ability to prepare written correspondence, reports and forms using prescribed formats and conforming to rules of punctuation, grammar, diction, and style on a regular basis.
• Requires the ability to apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions
• Performs substantial movement of wrists, hands, and fingers for continuous computer work.
• Extended hours required during peak workloads or special projects/events.

Travel Requirements:

• None