Mid-America Carpenters Regional Council Benefit Funds
Claims Manager
Mid-America Carpenters Regional Council Benefit Funds, Chicago, Illinois, United States, 60290
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The Claims Manager oversees the administration of health benefit claims within a union benefits fund, ensuring accuracy, timeliness, and compliance with plan rules, summary plan descriptions, and applicable regulations. This role is responsible for managing a team of claims analysts and processors, coordinating with The Funds medical network Blue Cross Blue Shield of IL, and supporting union members and their families through effective claims resolution and customer service.
Salary Range
$80,000 - $95,000
Responsibilities
Oversee daily operations of the claims processing unit for health benefit programs, ensuring timely and accurate adjudication of claims. Supervise and provide leadership to claims staff, including hiring, training, performance evaluations, and workflow management. Monitor and analyze claims processing metrics and trends to ensure productivity and compliance with regulatory and policy standards. Develop and implement policies and procedures to improve operational efficiency and accuracy in claim adjudication. Coordinate audits and reviews of claims to ensure quality control and compliance with plan documents, contracts, and applicable laws (e.g., ERISA, HIPAA, ACA). Serve as a subject matter expert on claims adjudication, resolving complex or escalated claim issues and appeals. Collaborate with IT and Bridgeway to maintain system integrity and enhance claims processing capabilities. Provide reporting and analytics to senior management on claims trends, costs, denial rates, and performance metrics. Stay up to date with industry’s best practices, regulatory changes, and innovative technologies in health claims administration. Other duties as assigned. Basic Qualifications
Bachelor’s degree in Health Administration, Business, Finance, or related field or a minimum of 10 years of experience in health benefits claims processing, with at least 5 years in a supervisory or managerial role. Strong knowledge of medical terminology, ICD/CPT coding, and healthcare reimbursement methodologies. Familiarity with health insurance regulations, including HIPAA, ACA, and ERISA. Excellent leadership, organizational, and critical thinking skills. Proficiency in claims processing systems and Microsoft Office Suite. Effective communication and interpersonal abilities. Ability to analyze data and prepare detailed reports. Preferred Qualifications
Experience collaborating with Blue Cross & Blue Shield & Bridgeway Work Authorization
No calls or agencies please. The Mid-America Carpenters Regional Benefit Services will only employ those who are legally authorized to work in the United States. This is not a position for which sponsorship will be provided. Individuals with temporary visas such as E, F-1, H-1, H-2, L, B, J, or TN or who need sponsorship for work authorization now or in the future, are not eligible for hire. Equal Opportunity Employer
The Mid-America Carpenters Regional Benefit Services is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, religion, national origin, age, marital status, political affiliation, sexual orientation, gender identity, genetic information, disability, or protected veteran status. We are committed to providing a workplace free of any discrimination or harassment.
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Oversee daily operations of the claims processing unit for health benefit programs, ensuring timely and accurate adjudication of claims. Supervise and provide leadership to claims staff, including hiring, training, performance evaluations, and workflow management. Monitor and analyze claims processing metrics and trends to ensure productivity and compliance with regulatory and policy standards. Develop and implement policies and procedures to improve operational efficiency and accuracy in claim adjudication. Coordinate audits and reviews of claims to ensure quality control and compliance with plan documents, contracts, and applicable laws (e.g., ERISA, HIPAA, ACA). Serve as a subject matter expert on claims adjudication, resolving complex or escalated claim issues and appeals. Collaborate with IT and Bridgeway to maintain system integrity and enhance claims processing capabilities. Provide reporting and analytics to senior management on claims trends, costs, denial rates, and performance metrics. Stay up to date with industry’s best practices, regulatory changes, and innovative technologies in health claims administration. Other duties as assigned. Basic Qualifications
Bachelor’s degree in Health Administration, Business, Finance, or related field or a minimum of 10 years of experience in health benefits claims processing, with at least 5 years in a supervisory or managerial role. Strong knowledge of medical terminology, ICD/CPT coding, and healthcare reimbursement methodologies. Familiarity with health insurance regulations, including HIPAA, ACA, and ERISA. Excellent leadership, organizational, and critical thinking skills. Proficiency in claims processing systems and Microsoft Office Suite. Effective communication and interpersonal abilities. Ability to analyze data and prepare detailed reports. Preferred Qualifications
Experience collaborating with Blue Cross & Blue Shield & Bridgeway Work Authorization
No calls or agencies please. The Mid-America Carpenters Regional Benefit Services will only employ those who are legally authorized to work in the United States. This is not a position for which sponsorship will be provided. Individuals with temporary visas such as E, F-1, H-1, H-2, L, B, J, or TN or who need sponsorship for work authorization now or in the future, are not eligible for hire. Equal Opportunity Employer
The Mid-America Carpenters Regional Benefit Services is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, religion, national origin, age, marital status, political affiliation, sexual orientation, gender identity, genetic information, disability, or protected veteran status. We are committed to providing a workplace free of any discrimination or harassment.
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