Health & Welfare Claims Manager - Participant Services

Summary:
The Chicago Laborers' District Council Benefit Fund Office is seeking a Claims Manager to manage the Health & Welfare Participant Services team. The Claims Manager role is a critical position within the organization – responsible for the oversight of our call center staff and for ensuring a high standard of customer service and membership care. In this role, the Claims Manager will provide our employees with coaching, encouragement, and assistance, as well as the implementation of methods to support meeting and exceeding set performance standards. Based on the performance results and the Claims Manager’s own observations, he/she will prepare and analyze reports, suggest operational improvements, suggest methods of performance measurement metrics, and develop new call strategies. This role will facilitate training of new employees. This role requires a keen understanding of claims operations principles and strong leadership skills to manage a team effectively. The Participant Services Claims Manager will be pivotal in suggesting the development of strategies to improve service levels and to ensure that call center strategies and technology are current with industry standards.

Areas of Responsibility:

Daily Management

• Review daily production reports to assess prior day performance and make necessary shifts.
  
• Oversee the management of all document queues, MSS inquires, and claims e-mail to within company policy guidelines and DOL standards.
  
• Participate in the creation of a comprehensive quality review program to include call monitoring as well as Service Form and Action Gram review and reporting.
  
• Weekly audits and performance reviews are essential to maintain high-quality service.
  
• Oversee CSR and Switchboard shift scheduling to ensure appropriate phone and switchboard coverage based on call volumes throughout each day.
  
• Manage attendance and out of office scheduling.
  
• Monitor service levels on daily, weekly, monthly, and quarterly basis to report accordingly.
  
• Analyze call data to identify trends and areas for improvement.
  
• Collaborate with other departments and vendors for comprehensive call management – building strong relationships is important for effective communication and problem-solving.
  
• Participate in member appeal preparation process.
  
• Direct interaction with members may be necessary to address and problem solve concerns or complex issues.
  
• Suggest process improvement and Best Practices opportunities.
  
• Develop and implement policies and procedures related to calls handling.
  
• Continuous improvement initiatives are part of this responsibility.
  

Supervisory

• Leading a team of customer service representatives and support staff is a primary responsibility.
  
• Provide ongoing training, guidance, and support to ensure that the staff meet performance goals.
  
• Fostering a collaborative environment to promote positive and productive team morale and productivity.
  
• Create an environment of excitement to support members and initiate creative methods of involving staff in operational enhancements.
  
• Manage a staff of 18+ bargained and non-bargained employees, including overseeing performance evaluation cycles.
  
• Participate in hiring, performance management processes, and termination decisions as needed.
  
• Ensure performance metrics support quality service delivery by creatively managing such metrics. Provide appropriate, individual, success geared coaching and/or set up additional training.
  
• Provide guidance to Participant Services leadership and staff regarding new guidelines, workflows, system enhancements, trainings, etc.
  
• Support staff by troubleshooting escalated claim/call issues from Local Business Agents, members and providers.
  
• Facilitate training of new hires, training on new systems, and refresher training on Plan guidelines, updates, and enhancements.
  
• Facilitate weekly meetings with overall technical staff, quarterly individual one on one meetings with customer service staff, and a quarterly meeting with entire customer service team.
  
• Lead by example in areas of integrity, transparency, character, and hard work.
  

Program Management

• Work closely with annual mailings.
  
• Support efficiency initiatives.
  
• Support Training Fund initiatives.
  
• Support Employer and Local Office informational visits/meetings.
  

Experience/Education/ Certifications:

• The position requires a minimum of five (5) years of benefits related experience and a minimum of three (3) years of supervisory/leadership experience. Previous experience in the Health & Welfare industry is required.
• Bachelor’s degree in related field or commensurate practical experience required.
  

Skills:

• Proficiency in Microsoft Word, PowerPoint, Outlook, Excel, and Teams is required.
  
• Working knowledge of regulatory environment: ERISA, HIPAA, COBRA, ACA, DOL, and other state and federal regulations.
  
• Customer oriented with excellent leadership, organizational, communication, time management, problem solving, decision making, follow-up and follow-through skills.
  
• Strong oral and written communication skills.
  
• Proven experience successfully managing multiple projects simultaneously and producing quality deliverables on time.
  
• Ability to assess situations and reach innovative and practical solutions to complex problems.
  
• Excellent analytical skills.
  
• Ability to manage staff effectively to encourage, counsel, mentor, and resolve conflict when necessary.
  
• A proven track record of managing complex issues effectively.
  
• A keen eye for detail is crucial to ensure accuracy and compliance.
  
• A strong focus on customer service is necessary to maintain positive member and Local Union staff relationships.
  
• Ability to prioritize member satisfaction – understanding the needs of members is vital.
  
• Ability to manage employees fairly and with care.
  

This is a permanent, full-time position that offers excellent pension, 401(k), health, Rx, dental, vision, life insurance and paid time-off benefits. Regular work hours are Monday through Friday from 8:30 a.m. to 5:00 p.m. however, job duties may require flexibility as needed. Salary Range: 85,000 - 95,000 annually.