Claims Manager

Benefits Paid Holidays Health Reimbursement Account Pensions Health insurance Paid time off Summary The Claims Manager is responsible for supervising, coordinating, and implementing a wide range of departmental projects and programs, as well as overseeing the day-to-day operations of the Claims Department. The Claims Department processes medical, dental, vision, disability, and HRA claims and provides customer service support to participants. Essential Duties and Responsibilities Process and audit all types of claims—including medical, dental, vision, HRA, and loss-of-time (short-term disability)—for active members and retirees. Ensure claims are processed accurately and meet quality, timeliness, and production standards. Research and resolve appealed, questionable, or denied claims to ensure fair and timely outcomes. Conduct phone monitoring to ensure quality service. Respond promptly and professionally to phone, written, and walk-in inquiries from participants, trustees, employers, and union representatives. Draft written correspondence regarding claim inquiries, determinations, and appeals. Coordinate programming updates and client communications for Plan changes. Run reports as needed. Analyze report data and notify Administrative Manager of concerns or recommendations for improvement. Collaborate with consultants, attorneys, and management on benefit interpretations, subrogation, workers’ compensation, and preparation of plan materials and booklets. Communicate and collaborate with vendors such as PBM, PPO, UR, Case Management, etc as needed. Support efforts to improve electronic claims productivity and auto-adjudication rates. #J-18808-Ljbffr OPERATING ENGINEERS LOCAL 139 HEALTH FUND