Health & Welfare Operations Claims Manager

The Chicago & Vicinity Laborers’ District Council Funds are seeking a Claims Manager to manage the Health & Welfare Operations’ Claims Adjuster team. This role entails managing and working closely with Claims Adjusters and Technical Support staff, implementing Best Practices, and staying current with industry trends related to technology and benefits.

The ideal candidate thrives in a fast-paced environment where managing several tasks and priorities at the same time is critical to success. The position requires a minimum of five years’ claims administration experience. Commensurate experience will be considered.

Areas of Responsibility:

• Daily review of production reports to assess prior day performance.
  
• Daily review and management of claims queues to maintain internal and external (DOL) standards.
  
• Daily, weekly, monthly, and quarterly review of personnel performance – attendance, quality, production and reviews – to effectively coach and identify training opportunities.
  
• Review of quality and production metrics in comparison to industry standards.
  
• Schedule recurring staff meetings and one-on-one coaching to ensure consistency with policies and procedures to foster staff development.
  
• Identify strategies to increase Auto Adjudication.
  
• Monitor industry trends related to technology and healthcare benefits trends.
  
• Collaborate within the department and with other departments to meet organizational goals.
  
• Assist in managing vendor relationships to ensure delivery of exceptional benefits to participants.
  
• Assist in managing participant appeals.
  
• Interact with participants to address and problem-solve concerns or complex issues.
  
• Suggest opportunities for the implementation of process improvements and best practices.
  
• Develop and implement policies and procedures to increase claim processing efficiency.
  
• Manage remote work schedule.
  

Other Areas:

• Understand and follow HIPAA policies and procedures.
  
• Continued professional development is required for the employee in this position.
  
• Coordinate participant communications and internal communications/training when benefit changes are made.
  
• Support efficiency initiatives.
  
• Assist with preparation of reports for Board of Trustees and Management, as requested.
  
• Support Affiliated Union organizations and employers with informational visits, meetings, and initiatives.
  
• Other duties as assigned.
  

Required Experience/Skills/Abilities:

• Bachelor’s degree in related field or commensurate practical experience required.
  
• Minimum of five (5) years of benefits administration related experience.
  
• Minimum of five (5) years of supervisory/leadership experience.
  
• Strong oral and written communication skills.
  
• Ability to learn current protocol quickly and infuse past experiences into new systems.
  
• Proven experience successfully managing multiple projects simultaneously and producing quality deliverables on time.
  
• Proficiency in MS Office Tools: Word, PowerPoint, Outlook, Excel, Teams
  
• Proficiency in claims management systems.
  
• Working knowledge of regulatory environment: ERISA, HIPAA, COBRA, ACA, DOL, and other state and federal regulations.
  
• A strong focus on customer service, quality, and accuracy.
  
• Ability to lead by example and manage staff effectively; encourage, coach, mentor, and support conflict resolution when necessary.
  
• High-level integrity, discretion, and attention to detail.
  
• Strong analytical and critical thinking skills.
  
• Ability to work independently with minimal supervision.
  
• Ability to adapt to the changing needs of the Organization.
  

Work Environment and Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
  
• Must be able to lift to fifteen pounds at times.
  

Salary Range: $90,000.00 - $100,000.00 (annual) commensurate with skills and experience.

Classification: Exempt from Overtime

This is a full-time exempt position that offers excellent health, dental, vision, pension, time off benefits, Member Assistance Program (MAP) and the option to participate in a voluntary employee funded 401(k) plan.