Job CodeY2726HFDepartment NameHealth Fund AdminReports ToDirector, Health Fund OperationsFLSA StatusExemptUnion CodeN/AManagementYesJob Summary:The Manager, Ancillary Benefits provides operational support to the Director, Health Fund Operations in strategic vendor relationships, day-to-day oversight, and performance accountability of the Health Fund's ancillary vendors, as well as managing vendor and Health Fund projects as necessary. Oversight of the vendors includes delivery of exceptional customer service, plan and regulatory compliance, monitoring the contracts for compliance, and measurement of the vendors' performance including analysis and recommendations based on reporting and performance guarantees.
Essential Duties and Responsibilities:- Works with leadership to evaluate, maintain, and enhance vendor relationships.
- Collaborates with vendors and internal teams to develop, prepare, and analyze operational and performance reports, including documenting submissions, reviewing trends, identifying outliers, comparing data with the Health Fund's Analytics team, and recommending reporting and process improvements.
- Meets regularly with vendors and internal teams to review performance, monitor open items, discuss trends, and maintain effective working relationships.
- Works with vendors and internal teams to resolve member issues in a timely manner, track performance guarantees, identify service deficiencies, and develop and monitor corrective action plans, as necessary.
- Monitors vendor performance and ensures key oversight, contractual, and operational deliverables are met and maintained by both vendors and Health Fund staff.
- Supports the Director, Health Fund Operations in organizing quarterly and annual meetings by preparing agendas, maintaining meeting minutes, tracking action items, following up on key deliverables, and assisting with annual strategic planning activities.
- Collaborates with the Director, Health Fund Operations and vendors to identify and address issues arising from the day-to-day management of vendor relationships.
- Reviews benefit administration issues and recommends process improvements, operational enhancements, and corrective actions, as appropriate.
- Identifies opportunities for benefit and service enhancements, in partnership with vendors and internal stakeholders, that support improved member outcomes and cost-management objectives.
- Assists the Director, Health Fund Operations in the design, implementation, testing, validation, and documentation of benefit changes.
- Communicates directly with vendors verbally and in writing regarding operational issues, plan administration matters, and benefit-related questions.
- Partners with Communications to inform Health Fund staff and members of health plan updates and benefit changes.
- Communicates approved health plan modifications to vendors and coordinates implementation, testing, and validation of system updates, including support for cross-functional implementation efforts.
- Supervises assigned staff, including establishing goals, managing and prioritizing workloads, providing coaching and feedback, and supporting employee development.
- Develops team members through performance and development plans focused on individual strengths and growth opportunities.
- Maintains quality service to vendors and internal stakeholders by ensuring team performance standards and service expectations are met.
- Oversees assigned projects, including establishing deadlines, coordinating resources, assigning responsibilities, monitoring progress, and communicating project status.
- Prepares reports and updates for management regarding project status, risks, and outcomes.
- Identifies organizational dependencies to ensure project requirements are documented and implemented appropriately.
- Serves as a liaison with vendors regarding project deliverables, testing, implementation activities, and issue resolution.
- Monitors vendor performance using service level agreements (SLAs), key performance indicators (KPIs), member experience metrics, and contractual performance guarantees.
- Partners with Communications to develop clear, accessible communication materials that help members understand and utilize their benefits.
- Performs other duties and special projects as assigned by management.
Qualifications (Competencies):- Bachelor's degree in Healthcare Administration, Health Sciences, Business Administration, or a related field; equivalent relevant experience in the health insurance or employee benefits industry may be considered in lieu of a degree;
- Minimum three (3) years of experience in health plan operations, ancillary benefits administration, vendor management, employee benefits administration, or a related filed;
- Strong knowledge of ERISA, HIPAA, and ACA requirements; experience with Taft-Hartley funds preferred;
- Demonstrated experience leading, developing, and motivating staff;
- Strong organizational and project management skills, with the ability to prioritize competing demands, meet deadlines, and manage multiple projects simultaneously;
- Proficiency in data analysis, reporting, and data visualization, including advanced use of Microsoft Office applications;
- Excellent communication, problem-solving, and relationship management skills;
- Proficiency in reading, writing, and speaking English is required; Spanish language skills preferred;
- Demonstrated ability to manage complex benefit administration processes while maintaining a high degree of accuracy and attention to detail;
- Commitment to delivering clear, responsive, empathetic, and high-quality service to members, vendors, and internal stakeholders;
- Ability to utilize data and performance metrics to support decision-making and identify opportunities for operational improvement; and
- Demonstrated ability to hold vendor partners accountable while maintaining effective and collaborative business relationships.
Education:Bachelor's degree in healthcare administration, Health Sciences, Business related field, or equivalent work experience in the health insurance industry.
Physical Demands:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.
Reasonable accommodations may be made to enable individuals to perform the essential functions.
Work Environment:Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
