Job Overview
We are seeking a dynamic and detail-oriented Senior Benefits Associate to join our Human Resources team. In this pivotal role, you will lead the administration and management of employee benefits programs, ensuring compliance with legal standards and delivering exceptional service to our workforce. . This is a Permanent position - 35 hours per week, with the primary responsibilities that include overseeing retiree benefits; administration of 2nd & 3rd level claim appeals; coordinating systems-related audits; administering year-end processing activities; managing class action settlements and participating in special projects & communications.
The individual will need to have Insurance experience (with claims, Medicare and Retiree Benefits) along with the following:
Duties:
- Coordinate retiree Health & Welfare benefits eligibility and coverage with the Pension Department. This entails (1) enrolling retirees in Horizon Blue Cross/Blue Shield, and Express Scripts coverage and (2) updating the AS400 database. Ensure the timely and accurate data entry of retiree health premium rates into GIBS System
- Manage the Funds Bronze Plan and annual Open Enrollment process. Responsible for ongoing communications with corporate offices to maintain eligibility and deductions for coverage. Update F-20 screens for eligibility related to Bronze plan enrollment, return to work, terminations, reinstatements, with correct effective dates.
- Facilitate 2nd and 3rd (external) level participant claim appeals, i.e., document 1st level appeal and vendor’s denial; summarize 2nd level appeal; review appeal with Manager and Assistant Fund Administrator and, if appropriate, submit appeal to applicable Trustee Claim Appeal Subcommittee for consideration. If 2nd level appeal is denied and appealed, coordinate 3rd level appeal with Horizon (medical) or initiate the appeal process with contracted IRO (prescription drug).
- Handle phone calls related to life Insurance claims and record the pertinent information for the requisite beneficiary communication. Complete Fund portion of Life Insurance claims and submit them to carrier.
- Obtain Monies due to the Funds from class action-related drug settlements.
- Ensure Fund compliance with Creditable Coverage Notice regulations by monitoring Notice distribution and documentation of same.
- Responsible for ensuring accurate participant eligibility and enrollment with third-party vendors.
- Generate requisite data for annual valuation reporting and coordinate Summary Annual Report (SAR) mailings for applicable plans.
- Provide plan participant / retiree support, i.e.,
- Respond to requests for medical, dental and vision claim forms, address changes and benefits-related communications.
- Verify phone inquiries concerning plan eligibility, coverage and termination dates; including overflow in COBRA Dept.
- Verify and mail medical / dental ID Cards – updating AS400 Notes, as appropriate;
- Responsible for 1095B Record keeping. Maintenance to obtain accurate Social Security numbers on file by sending letters in response to 1095B error reports.
- Verify employment, department changes, LOA status with store / employer for participants reported on data integrity reports, agents correspondence or store reports, i.e. Stop & Shop. Fund management notified for requisite system updates.
- Update participants records (AS400 – Sessions / Notes) based on his/her Fund-related transaction – primarily to document the reason for the contact and the actions taken, e.g., status changes, mailings, etc.
- Team with H&W Department Manager and Assistant Fund Administrator to effectively implement benefit programs and/or benefit / vendor-related changes initiated by Fund Trustees, the collective bargaining process or required by legislative and/or regulatory developments
Pay: $47,000.00 - $50,000.00 per year
Benefits:
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
