Benefit Claims Supervisor

BENEFIT CLAIMS SUPERVISORBASIC FUNCTION:Under the direction of the FBC Program Manager, organize, coordinate, direct and manage various aspects of claims administration for self-funded indemnity plans for the Consortium; provide technical expertise; train, supervise and evaluate the performance of assigned personnel.REPRESENTATIVE DUTIES:Perform a variety of duties in the management and administration of self-funded indemnity fringe benefit plans. EDevelop, maintain, administer and manage claims procedures, audit procedures and criteria, and customer service related functions in accordance with applicable benefit plans. EDirect and coordinate various aspects of reinsurance submissions including implementation of case management, early carrier notification and coordination of vendors as applicable. EDirect and coordinate third party liability recoveries. EInteract with and oversee contracted vendor operations pertaining to the indemnity plans. EOversee on-line benefit plan maintenance, eligibility and reporting functions and training including interaction with the claims data system software vendor as necessary. ETrain, supervise and evaluate the performance of assigned personnel. EAssist with benefit plan design development and plan document updates.Maintain current knowledge of fringe benefit claims related rules and regulations, including HIPAA; review and analyze pending legislation.Attend a variety of meetings and conferences; prepare and deliver oral presentations as required.Perform related duties as assigned.KNOWLEDGE AND ABILITIES:KNOWLEDGE OF:Medical and dental, self-funded claims administration.Medical coding and fee schedules.Typical eligibility and generally accepted claims practices.Principles and practices of supervision and training.Government plans including Medicare, Medicaid, Champus and others.Reinsurance contracts, submissions and recoveries.Health and safety regulations.Oral and written communication skills.Record-keeping techniques.ABILITY TO:Organize, coordinate, direct and manage various aspects of claims administration for self-funded indemnity plans for the Consortium.Train, supervise and evaluate the performance of assigned personnel.Direct and coordinate third party liability recoveries.Maintain current knowledge of fringe benefit claims related rules and regulations.Communicate effectively both orally and in writing.Establish and maintain cooperative and effective working relationships with others.Analyze situations accurately and adopt an effective course of action.Work independently with little direction.Plan and organize work.Meet schedules and time lines.Interpret, apply and explain rules, regulations, policies and procedures.EDUCATION AND EXPERIENCE:Any combination equivalent to: a bachelor’s degree in business administration or related field and at least five years of claims related experience including two years of recent supervisory experience.WORKING CONDITIONS:ENVIRONMENT: Office environment.PHYSICAL ABILITIES: Hearing and speaking to exchange information and make presentations. Seeing to read a variety of materials.