Health & Welfare Claims Manager - Processing

Summary:
The Chicago Laborers' District Council Benefit Fund Office is seeking a Claims Manager to manage the Health & Welfare Claims Adjuster team. The Claims Manager role is a critical position within the organization, responsible for overseeing the claims process from the initiation of the claim, through resolution, to ensure efficiency, and to ensure DOL and other regulations compliance. This role requires a keen understanding of Health & Welfare principles and strong leadership skills to manage the Adjuster team effectively. A highly critical area is that of managing a Claims Adjuster and Technical Assistant team and ensuring a high standard of quality and productivity. 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 continually collaborate with the team and management to assess and implement Best Practices. This role will facilitate training of new employees. The Processing Claims Manager will be pivotal in spearheading the development of strategies to continually improve service levels, reduce cost, and enhance overall quality. A critical responsibility is that of monitoring technology and working with the IS Department to ensure we are working as efficiently and as smart as possible. The Claims Manager will be pivotal in developing strategies to improve claims processing and member satisfaction.

Areas of Responsibility:

Daily Management

• Review daily production reports to assess prior day performance and make necessary shifts.
  
• Ongoing claims-on-hand review and management of queues within DOL standards.
  
• Weekly review of production and quality reporting with coaching and identification of training needs where appropriate. Weekly audits and performance reviews are essential to maintain high-quality service.
  
• Monthly and quarterly review of performance – quality and production.
  
• Oversight of Adjuster inboxes to ensure DOL compliance and timely handling.
  
• Collaborate with other departments and vendors to build strong relationships, which 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 claim processing.
  
• Continuous improvement initiatives are part of this responsibility.
  
• Collaborating with IT to stay abreast of the latest technology tools that enhance claims processing. Familiarity with claims management software and data analytics tools is essential.
  
• Suggesting new technologies which can lead to improved efficiency and accuracy in claims handling.
  
• Continual monitoring of the Auto Adjudication process and working to enhance it is critical.
  
• Ensuring that claims processes meet regulatory requirements is a crucial part of the role. The Claims Manager must stay updated on industry regulations and best practices. Regular compliance audits and training sessions for the team may be necessary.
  
• Providing ongoing training and development opportunities for the claims team is essential for skill enhancement. The manager should facilitate workshops and mentorship programs to foster employee growth. This investment in talent is beneficial for retention and overall performance.
  
• Continual analysis and monitoring performance metrics for the claims team is crucial for assessing efficiency.
  
• The Claims Manager will develop and implement policies and procedures related to claims handling. This ensures that all practices are compliant with legal requirements and industry standards.
  

Supervisory

• Leading a team of Claim Adjusters and Technical Assistants 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 Adjuster team, members, and to initiate creative methods of involving staff in operational enhancements.
  
• Manage a staff of 12+ bargained and non-bargained employees, including overseeing performance evaluation cycles.
  
• Manage attendance and out of office scheduling.
  
• 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 Adjuster leadership and staff regarding new guidelines, workflows, system enhancements, trainings, etc.
  
• Support staff by troubleshooting escalated claim issues.
  
• 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 Adjuster staff, and a weekly meeting with entire Adjuster 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 Health & Welfare benefits administration related experience and a minimum of five (5) years of supervisory/leadership experience in a claims or financial environment.
• 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 overall service and quality 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, dental, Rx, life insurance, vision 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: 85,000 - 95,000 annually