OverviewPosition SummaryThe Supervisor, Health & Welfare Claims is responsible for leading a team of Claims Adjusters and overseeing the accurate, timely, and compliant processing of health and welfare claims. This role serves as a key operational resource, providing day-to-day direction, staff development, and escalation support while maintaining the high standards of service our members depend on. The Supervisor works cross-functionally with internal teams and external partners - including PPO Network Representatives - to resolve issues, drive process consistency, and ensure claims are processed within established deadlines.
Responsibilities- Lead, mentor, and develop a team of Claims Adjusters, fostering a culture of accountability, continuous improvement, and exceptional service delivery.
- Oversee and optimize claims workflow to ensure all claims are processed accurately and within the required 30-day processing deadline.
- Personally adjudicate high-dollar-value claims in accordance with established thresholds and plan guidelines, ensuring accuracy and compliance.
- Serve as the primary escalation point for complex or disputed claims, providing guidance and resolution support to staff.
- Partner with PPO Network Representatives to resolve claims inquiries, discrepancies, and issues in a timely and professional manner.
- Collaborate with fellow supervisors and department managers to align operational strategies and drive consistency across the Claims Processing function.
- Design and deliver onboarding and ongoing training programs that equip staff with the knowledge and tools needed to perform at their best.
- Conduct annual performance evaluations and manage employee relations matters with professionalism, fairness, and a coaching mindset.
Qualifications- Ideal candidate will possess supervisory or team lead experience.
- Candidates with claims processing experience will be viewed favorably.
- In-depth knowledge of Health & Welfare benefit plans is beneficial.
- Experience with Facets claims processing system (or a similar system) a plus.
- Strong analytical and problem-solving skills, with a demonstrated ability to research, interpret, and resolve complex claims issues.
- Exceptional interpersonal and communication skills, with the ability to effectively engage with team members, cross-functional partners, and external vendors.
- Highly organized and self-directed, with the ability to manage competing priorities in a deadline-driven environment.
- Bachelor's degree is highly desirable.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook); experience with claims management or benefits administration software.
CompensationAnnual Salary Range: $75,000 - $88,000 annually
(The posted range of pay represents the anticipated pay scale for this position. Final pay will be determined based on a variety of job-related factors, including, but not limited to, skills, experience, education, certifications, internal equity, and organizational needs.)
Benefits*We're proud to offer one of the most competitive total rewards packages in the nonprofit and benefits administration sectors, including:
- 100% company-paid family insurance benefits including health, dental, RX & vision
(comprehensive coverage with low deductibles)
- 100% company-funded pension plan (at no cost to the employee)
- Health care and dependent care Flexible Spending Accounts (FSAs)
- 401(k) retirement plan with company match
- Paid vacation and PTO days
- Flexible start times & hybrid work-from-home schedule
- Lunch stipend for onsite café
- Tuition reimbursement
* Please note that, though uncommon, the benefits described above are subject to change at the company's discretion.
