Overview

Position Summary

The 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.
• Bachelors degree is highly desirable.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook); experience with claims management or benefits administration software.

Compensation

Annual 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*

Were 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 caf
• Tuition reimbursement

* Please note that, though uncommon, the benefits described above are subject to change at the companys discretion.