Senior Claims Director

Job Description

The UFCW National Health & Welfare Fund (“Fund”), headquartered in Englewood, New Jersey, is seeking an experienced Senior Claims Director to provide operational and strategic leadership for the Fund’s self-administered medical and hospital claims administration function. This on-site position provides the opportunity to build strong working relationships and collaborate closely with colleagues at the Fund’s Englewood, New Jersey office. The role is fully in person and does not offer remote work.

The Senior Claims Director will oversee day-to-day claims payment operations, staff, systems, policies, and processes to ensure claims are paid accurately, timely, and in accordance with Plan provisions and applicable regulatory requirements. The Fund administers health benefits, including payment of medical and hospital claims, for approximately 8,384 active members and eligible dependents and approximately 463 retirees and beneficiaries. A satellite claims office is maintained in Stockton, California.

This is a key leadership position that will work closely with the Executive Director as a trusted partner and senior operational resource. This position represents more than an opportunity to lead a claims department. The Senior Claims Director will be an important member of the Fund’s leadership team, work closely with the Executive Director and Trustees, and serve as a key backup when needed.

As part of the Fund’s long-term succession planning, the successful candidate will gain exposure to broader Fund administration and strategic initiatives and will have the opportunity to expand their responsibilities over time.

Key Responsibilities

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• Provide strategic and day-to-day leadership of the Fund’s health claims operations, ensuring accurate and timely claims administration and exceptional participant service.
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• Lead, coach, mentor, and develop collectively bargained claims staff, establishing a culture of accountability, collaboration, continuous improvement, and professional growth.
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• Develop, implement, and monitor claims policies, procedures, workflows, performance standards, quality assurance, and internal controls.
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• Ensure benefits are administered in accordance with Plan documents, policies, and applicable regulatory requirements.
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• Monitor claims inventories, turnaround times, accuracy, service levels, and other performance measures and address emerging issues proactively.
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• Oversee complex claims and benefit appeals and serve as the senior escalation resource for claims and participant issues.
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• Partner with system providers to ensure claims and benefit administration systems effectively support Plan requirements and operational needs.
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• Manage and work with PPO networks and other medical service providers supporting the Fund.
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• Use data and analytics to identify trends, improve performance, strengthen controls, and identify opportunities for greater efficiency and automation.
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• Lead process improvement and operational change initiatives designed to enhance claims administration and participant service.
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• Work closely with the Executive Director on operational priorities, staffing, participant service, organizational initiatives, and other matters affecting the Fund.
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• Serve as a trusted advisor and backup to the Executive Director, providing leadership continuity when needed and developing a broader understanding of Fund operations.
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• Maintain effective relationships with staff, Trustees, participants, employers, union representatives, professional advisors, vendors, and other stakeholders, as appropriate.
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• Stay current on regulatory, industry, technology, and health benefits developments that may affect the Fund and its operations.
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Qualifications

The ideal candidate will have:

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• Educational Background: Bachelor’s degree or an equivalent combination of relevant medical claims payment and management experience required. CEBS certification, other relevant credentials, or an advanced degree is a plus.
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• Work Experience: A minimum of seven (7) to ten (10) years of progressively responsible experience in medical and hospital claims payment and administration, health plan operations. At least five (5) years of significant management and leadership experience, including demonstrated success leading, coaching, and developing claims staff is required. Experience managing collectively bargained staff is strongly preferred.
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Special Skills or Credentials:

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• Experience in a multiemployer, Taft-Hartley, collectively bargained or similar benefits environment strongly preferred.
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• Strong knowledge of medical claims administration, health and welfare benefits, insurance arrangements, and medical terminology, including CPT, ICD-10, DRG, and related healthcare coding concepts.
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• Proven ability to lead, motivate, develop, and hold staff accountable.
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• A collaborative and accessible leadership style coupled with sound judgment and decisiveness.
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• Confidence and judgment to step in for the Executive Director when needed.
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• Strong executive presence, integrity, discretion, and professionalism.
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• The ability to think strategically while remaining engaged in day-to-day operations.
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• Strong analytical, organizational, project leadership, and problem-solving skills.
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• Knowledge of regulatory requirements affecting health and welfare plans, including ERISA, HIPAA/HITECH, ACA, and COBRA.
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• Experience with claims processing and benefit administration systems and using data and analytics to improve operational performance.
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• Excellent communication skills and the ability to build effective relationships at all levels of an organization.
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To Apply

In addition to a salary range of $170,000 to $195,000 commensurate with experience, the Fund offers a comprehensive benefits package that includes employer paid healthcare, defined contribution and defined benefit retirement plans, and generous paid leave. The Fund is an affirmative action employer and encourages applications from all qualified candidates regardless of gender, race, ethnicity, age, sexual orientation, marital status, religion, or disability.

To apply, please send your resume and salary requirements to View email address on ziprecruiter.com. Please include job reference code 1026UFCWNJLI in the subject line or with your application.