Health & Welfare Services Supervisor
At UFCW & Employers Trust, every one of our staff is committed to providing efficient, responsive, friendly service and accurate information to serve all of our constituencies: our employee members, dependents, local unions, employers and service providers.
If you are looking for a an excellent opportunity in a great work environment, first class benefits, and opportunities to grow professionally, UFCW & Employers Trust wants to hear from you! We are currently seeking an Health & Welfare Services Supervisor professional to join our winning team.
In conjunction with the Health and Welfare Services Manager, the Health and Welfare Services Supervisor is responsible for day to day supervision of staff that comprise the three units of the Health & Welfare Services Department:
- Member Services: A phone unit responsible for answering Health & Welfare benefits questions for active members, retirees, and providers.
- Eligibility: A paperwork unit that processes documents related to active members, retirees, and providers.
- Claims: A claims processing unit that is responsible for releasing payments to active members, retirees, and providers.
The Acting Health and Welfare Supervisor will ensure that the daily work distribution of each unit. This includes but is not limited to daily review of performance metrics for each area and timely communication of improvement needed with specified staff, identifying areas of business process improvement and possible solutions, and reviewing review and ensuring accuracy of timecards and adherence to with collective bargaining provisions, and appraisal documentation on a daily basis.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Supervises call center leads, claims processing leads, call center representatives, claims processors, and eligibility assistants.
- Completes the daily work distribution to ensure daily claims activities of processing of medical, dental, mental health and sick leave claims, payments to providers and members, stops payments and reissues, recovery of overpayments, self-funded payments and collection arrangements, and as needed, coordinates with other departments to ensure timely claims processing.
- Daily supervision of customer call center staff: reporting of call center metrics, fulfillment of individual member requests, management and timely responses to inbox submission, scripted and timely responses to website e-mail inquiries, updating of training materials, implementation of new processes or procedures in support of business needs, and development of call scripts as directed.
- Supervises the staff of the Eligibility area and ensures the daily work distribution including accuracy of benefit matrix for vendor utilization and accurate eligibility reporting to vendors, error resolution, receipt and retention of all enrollment paperwork, COBRA administration, and participation in the renewal and open enrollment activities.
- Oversees the processing of specialty claims including third party claims, death benefits, PPOC, MSPRC, and hospital claims.
- Tracks and updates daily individual and department claims processing statistics to manage quality assurance, employee performance, and work distribution.
- Performs quality monitoring of telephone conversations and call audit reviews. Provides feedback and coaching to staff as needed.
- Performs quality monitoring of telephone conversations, system notes, letters, and quantity of claims processed to ensure department performance, quality and member goals are met.
- Recommends improvements to policies, standard operating procedures, and workflows to meet department performance, quality and member goals, and implements as directed.
- Supervises and provides performance feedback, guidance, training, motivation, performance appraisals, and support to staff.
- Delivers performance coaching and training to assigned staff, including call center staff and claims processing staff in order to accomplish the organization's goals.
- Enforce Office Policies, Collectively Bargained Agreements, State Law, and Federal Law in managing non-exempt collectively bargained employees.
- Completes timecards to ensure they are completed timely, accurately, in accordance with office policies, Collectively Bargained Agreements, State Law, and Federal Law for non-exempt collectively bargained employees.
- Participates in the phone interview process for the hiring process, new employee orientation and training, ensures the timely development of performance appraisal, communicates job expectations, enforces policies and procedures, coaching, and administers discipline.
- Communicates department level quality assurance and improvement goals as well as individual adjustor quality improvement expectations.
- Participates in data validation, coordinate and participates in the testing of upgrades and enhancements of the current software. Participates in creating testing scenarios to ensure upgraded programming matches Summary Plan Description language. Review of system upgrades or annual system workflows.
- Coordinates and communicates with vendors to troubleshoot and resolve issues that prevent the finalization of claims.
- Coordinates staffing and work assignments with other Supervisors as necessary.
- Responds to elevated calls from members, providers, and union representatives. Responds to and resolves more complex or sensitive complaints/issues. May assign call back to staff for research and follow up or elevate call to Health & Welfare Services Manager if necessary. Oversees follow up process until all inquires/issues are resolved.
- Directs staff how to resolve routine and non-routine member service issues.
- Prepares memos, emails and other communication to address global issues with telephone conversations.
- Assists in development of tools to assist staff in efficiently providing quality service to our members.
- Assists in review of data exports for mailings, vendor eligibility files, etc.
- Supervises and coordinates the distribution, processing, storing and auditing of paperwork to ensure the timely and accurate eligibility processing.
- Oversees and supervises mailroom activities to ensure incoming mail is opened and distributed to the correct person in a timely manner and to ensure outgoing mail is metered correctly.
- Trains staff on completing and processing paperwork. Provides additional training and support to staff as needed.
- Clearly communicates changes in policy and procedure that affect eligibility paperwork.
- Audits paperwork completed by staff for accuracy and completion.
- Monitors the open enrollment and special reports to ensure eligibility information is accurate. Reconciles discrepancies or assigns and supervises staff to reconcile discrepancies.
- Participates in open enrollment planning meetings.
- Reviews member communications and assists with testing on-line products to ensure the information is easy to understand and complies with the appropriate laws, regulations and eligibility requirements.
- Participate in company education fairs.
- Participate in project development and implementation.
- Responsible for keeping inventory of office and coffee supplies ensuring the office has needed supplies at all times.
MINIMUM JOB REQUIREMENTS
- Associate's degree in a related field and 3 years of related experience, including supervisory experience.
- A combination of appropriate education and experience may be substituted for the minimum education and experience requirements.
- Experience in a collectively bargained environment.
KNOWLEDGE, SKILLS AND ABILITIES REQUIREMENTS
- Excellent written and verbal communication skills necessary to develop and maintain effective and appropriate working relationships with co-workers and external vendors.
- Skill in assigning, prioritizing, monitoring, and reviewing work assignments.
- Ability to work effectively in a team environment.
- Ability to handle confidential information with discretion and tact.
- Ability to prioritize and work independently on projects with minimal supervision.
- Ability to detect errors, determine causes, and make corrections as appropriate.
- Ability to successfully resolve issues in a timely manner.
- Proficiency in the use of (or ability to learn) personal computer software or systems applicable to the essential functions of the job, which may include any or all of the following: email/calendar software, internet/intranet browsers, word processing, spreadsheets, database software, and various systems or software used by office.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
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 with disabilities to perform the essential functions.
Work is performed in a standard office environment with possible minor inconveniences due to occasional noise, crowded working conditions, and/or minor heating, cooling, or ventilation problems. While performing the duties of this job, the employee is required to:
- Sit (regularly)
- Stand or walk (occasionally)
- Talk or hear (regularly)
- Use hands to finger, handle or feel (regularly)
- Reach with hands and arms (regularly)
Vision abilities required by this job include close vision and the ability to adjust focus. The employee is regularly required to lift and/or move up to 10 pounds and may occasionally be required to lift and/or move up to 30 pounds (such as a box of paper).
The intent of this job description is to provide a representative summary of the major duties, responsibilities, and requirements of this job. This document does not prescribe or restrict the tasks that may be assigned. Employees may be requested to perform job-related tasks other than those specifically presented in this description. This document is not a contract between the employee and the organization. The job duties and essential functions may change.
Proudly serving over 184,000 participants from over 144 employers in the grocery and pharmacy industry, we administer Health & Welfare and Pension benefits. With a team of 200 employees in two offices located in Concord and Roseville, the TFO is fun and fast paced. In business since 1958, this organization is driven on the value of providing the highest level and quality of service to our participants. Check out our current job openings at the TFO and see how you can impact your career and enhance your skill set.
Tue, 18 Apr 2017 10:02:31 PDT