Benefits Administration Manager

Job Description

Job Description

Job Posting: Benefits Administration Manager

Job Description

The Cow Creek Band of Umpqua Tribe of Indians invites applications for the full-time position of Benefits Administration Manager. This crucial role is based in our headquarters and is not eligible for remote work. As the Benefits Administration Manager, you will lead the administration of the Nesika Health Plan, a self-funded and self-administered health plan dedicated to serving both employees and Tribal Members. This role demands proactive oversight of health plan operations including member eligibility, claims processing, and vendor coordination to ensure efficient and effective service delivery in line with established guidelines.

The successful candidate will work closely with the Director of Benefits and Risk Management to oversee the health plan’s daily operations, ensuring that all processes adhere to the governing documents and regulatory requirements. This position is integral in maintaining the integrity of the health plan, optimizing operational performance, and steering the strategic management of plan costs and risks.

Duties and Responsibilities

• Manage the daily operations of the self-funded, self-administered health plan and Tribal programs, supporting the Director of Benefits Administration and Risk Manager.
• Review complex or unusual benefit queries and make recommendations for appropriate plan administration.
• Interpret plan provisions and provide authoritative guidance on coverage, exclusions, limitations, and administrative requirements to staff, members, and leadership.
• Promote and ensure responsive, respectful and accurate service delivery to all stakeholders.
• Direct the administration of appeals, grievances, benefit inquiries, ensuring responses are timely, clear, and compliant with plan requirements.
• Establish and maintain quality control procedures including regular claim audits and corrective action protocols.
• Handle claim corrections, overpayment recoveries, refunds, and liaise with legal and financial teams on subrogation and third-party liability issues.
• Develop and disseminate clear, effective communications pertaining to member eligibility, benefits, claims, and any plan changes.
• Identify training needs and develop programs to enhance understanding of plan provisions and administrative procedures among staff.
• Monitor claim payments and administrative expenses to ensure proper authorization, documentation, and financial tracking.
• Assist with budgeting, forecasting, financial analysis and planning related to health plan management.
• Support compliance with all relevant healthcare regulations including HIPAA, ACA, COBRA, and ERISA.

Requirements

• Associates Degree or greater in a related field.
• Minimum five years of experience in employee benefits, health plan administration, or related field.
• At least two years of supervisory, lead, or management experience.
• Health and Life State License, or ability to obtain within 6 months of hire.
• Proficient in provider billing, medical coding, and utilization management.
• Strong skills with claims administration systems, eligibility systems, Office 365, and other relevant reporting tools.
• Excellent analytical and problem-solving abilities.
• Comprehensive knowledge of medical and prescription benefit terminology and claims processing.
• Current and valid Oregon Driver’s License with eligibility for the Cow Creek Government Office Driver’s Program.

BENEFITS OFFERED:

• Nesika Medical, Dental, Vision, Prescription Benefit - Eligible the first of the month following 60 days of employment
• Short Term/Long Term Disability - Company paid
• 401K – 7% Tribal Contribution - Eligible first quarter following 90 days of employment
• 15K Life Insurance policy – Company paid
• Flexible Spending Account – Up to $3400.00
• Recuro Care (Telemedicine) – Company paid with Nesika medical enrollment
• Employee Assistance Program
• Fuel Discount Card – .20 cents off a gallon at the Seven Feathers Truck & Travel Center
• Costco Reimbursement – up to $65.00 per year
• PTO – Exempt employees are front loaded PTO at the beginning of each year according to the years of service accrual rate with a cap of 600 hours
• Years of Service Recognition