Director, Health Claims Administration

About Us:
National Elevator Industry Benefit Plans (NEIBP) administers the health insurance and retirement benefit plans for members of the International Union of Elevator Constructors (IUEC). NEIBP offers comprehensive medical coverage, prescription drugs, dental, vision, hearing as well as a defined benefit pension and 401(k).

About the role:
The Director, Health Claims Administration will direct and oversee all operations of the Claims Department, ensuring timely, accurate and compliant claim submissions. This is achieved by the oversight of the claims teams, developing policies and procedures, developing training programs, monitoring performance metrics and staying update on industry regulations and legislation, as well as any directives provided by the Board of Trustees. The Director, Health Claims Administration is responsible for providing expert guidance to staff, promoting and maintaining excellent customer service, and promoting a positive work environment.

Key responsibilities include:

• Responsible to provide direction and supervision for all Claims Department operational and management processes,
  
• Responsible for the implementation of performance standards, staff review and evaluation, quality control and other programs,
  
• Responsible for the timely and professional communication with the Board of Trustees, Union Officers, Plan Participants, vendor representatives, service providers, and Benefits Office staff. This position is viewed as one of the principal spokespersons for the Health Benefit Plan and in-house expert on all benefit aspects of the Plan,
  
• Present claim appeals to the Board of Trustees including all background information and a Plan recommendation.
  
• Present a status report of Claims Department activities and current issues to the Executive Director,
  
• Responsible to develop, direct and maintain excellent working relationships with the NEIBP IT Department, Bridgeway Technologies., Plan consultants and other vendors to ensure that the systems and staff properly adjudicate claims based on current Plan guidelines and contracts,
  
• Oversees the development and measurement tools to assess the Claims Department’s overall effectiveness in meeting its business plan objectives,
  
• Assist the Executive Director as required and will act in the Executive Director’s absence in matters pertaining to the Claims Department,
  
• Meet with the Executive Director to discuss developments and ideas regarding the self-administration of medical dental, vision, weekly income claims,
  
• Responsible for Department compliance will all regulatory requirements, including but not limited to HIPAA and PHI.
  
• Responsible for maintaining the approved budget for the claims department,
  

About you:

• Minimum of a bachelor’s degree in healthcare administration, business administration or related field,
  
• Minimum of 10 years of progressive responsibility in health claims,
  
• Expertise in healthcare regulations and compliance requirements,
  
• Extensive experience in healthcare claims processing and management.
  
• Must be able to demonstrate superior management and leadership skills.
  
• Must be able to demonstrate good judgement and decision-making capabilities.
  
• Must demonstrate excellent interpersonal and communication skills.
  
• Must be detail oriented, highly self-motivated and able to manage time effectively.
  
• Demonstrated successful experience in claims adjudication functions.
  
• Excellent writing and speaking skills. Ability to deliver clear guidelines to all levels of management including the Board of Trustees
  
• Ability to work successfully at a self-directed pace in a changing, multi-task environment.
  
• Thorough understanding of medical and health plan terminology / procedures.
  
• Must be able to travel 10-20% to offsite meetings and conferences
  

What you can expect from National Elevator Industry Benefits Plans:

• Competitive salary
  
• Comprehensive benefits package including
  
  • Medical
    
  • Dental
    
  • Vision
    
  • Prescription
  • Disability
• Generous Paid time off
• Pension
  
• Safe Harbor 401(k) contributions
  

To apply please send your resume to [email protected].