Claims and Benefits Manager
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Job Location:
Baltimore, MD - USA
Monthly Salary:
Not Disclosed
Posted on:
4 hours ago
Vacancies:
1 Vacancy
Job Summary
Introduction
Marylands Family and Medical Leave Insurance (FAMLI) program makers sure all workers in Maryland have paid time off for medical and family reasons. FAMLI is a social insurance system covering 2.6 million workers and 180000 employers delivered as a digitally native public-facing services. Were in the early stages of building something as big as far-reaching as unemployment insurance or a new health department. We know that delivering services primarily through a website over the Internet is a new way of doing business in government.
The Claims and Benefits Directorate is responsible for ensuring prompt and accurate processing of paid leave claims and insurance of benefit payments to eligible workers.
As a senior leader of the Claims and Benefits Directorate the Claims and Benefits Manager will report to the Director of Claims and Benefits and will assist with developing and implementing the Claims and Benefits staffing structure daily operations and procedures and ensuring that state policies and regulations are met by the department.
GRADE
22
LOCATION OF POSITION
Maryland Department of Labor
100 S. Charles Street
Baltimore Maryland 21201
Main Purpose of Job
The Claims & Benefits Manager is one of the senior leaders of the Claims & Benefits Directorate in the Division of Family and Medical Leave Insurance (FAMLI) at the Maryland Department of Labor (MD Labor). During the build phase of FAMLI the Claims & Benefits Manager will develop processes and procedures to ensure paid leave claims are processed accurately and timely. The Claims and Benefits manager will also develop processes and procedures relating to adjudication of potentially disqualifying issues and the reconsideration of previous denials. The Manager will collaborate with the FAMLI Policy Digital Services Insurance Plan Compliance and Customer Care teams when creating policies and procedures. The Claims & Benefits Manager is an essential team member and is crucial to the success of the Claims & Benefits team which is at the heart of FAMLIs mission to ensure working Marylanders can afford to take time off to care for their loved ones and themselves.
POSITION DUTIES
Duties of this position include but are not limited to:
- Work closely with the Director of Claims and Benefits to determine the most appropriate and efficient organizational structure for the Claims and Benefits Directorate;
- Drafts MS-22s for necessary positions within the Claims and Benefits Directorate;
- Serve as hiring manager and oversee hiring onboarding and training of Claims and Benefits staff;
- Work with the Director of Claims and Benefits to draft FAMLI-specific positions for the Claims and Benefits directorate;
- Establishes adjudication policies and procedures for the Claims and Benefits Directorate;
- Establishes reconsideration policies and procedures for the Claims and Benefits Directorate;
- Oversees the implementation of policies and procedures evaluates their effectiveness and revises policies and procedures when needed;
- Work closely with other FAMLI directorates to build a case management system for Claims and Benefits staff;
- Investigate operational problems and propose solutions to FAMLI leadership;
- Claims intake and processing (in person or virtually) as needed if increased volume backlog/overflow or coverage issues occur;
- Approves timesheets for team members;
- Manages scheduling and approves leave to ensure the team is properly staffed;
- Investigate operational problems and propose solutions to FAMLI leadership;
- Performs other related leadership duties required;
- Complete performance reviews and evaluations (PEP);
- If necessary ensure corrective actions are taken for those not meeting expectations (PIP);
MINIMUM QUALIFICATIONS
Education:
A Bachelors degree from an accredited college or university.
AND
Experience:
Ten (10) years of experience of professional experience in program or operations management in a large or complex environment. Six (6) years of experience in administrative staff or professional staff work. Two (2) years of this experience must have involved one or more of the following: the supervision of other employees applying rules and regulation or exercising responsibility for the development of policies or procedures and an additional four years of experience in a public or private agency related to rendering and /or determining eligibility for Human Service Program or an insurance claims processing and fraud investigation program.
Notes:
1. Candidates may substitute and additional six (6) years of experience in administrative staff or professional staff work for the four (4) additional years of experience. One (1) year of this experience must have involved one or more of the following: the supervision of other employees applying rules and regulations or exercising responsibility for the development of policies or procedures.
2. Candidates may substitute additional graduate level education at an accredited college or university at the rate of 30 credits hour on a year-for-year basis for the required general experiences.
DESIRED OR PREFERRED QUALIFICATIONS
- Advanced Degree or Masters Degree is preferred.
- Strong verbal and written communication skills with the ability to communicate complex information clearly is preferred.
- Experience in:
- Paid leave unemployment insurance workers compensation or any other private or public benefits administration program.
- Standing up new government programs.
- Drafting standard operation procedures policy and/or complex documents.
- Strategic planning and implementing organization-wide initiatives.
- Supervising and leading multiple teams or units including supervisors.
- Process improvement systems modernization or technology implementation.
- Interpreting and applying state or federal laws regulations or administrative policies.
SPECIAL REQUIREMENTS
All candidates are subject to a background check against files maintained by the Division of Unemployment Insurance (Labor/DUI) to determine whether any monies are owed to Labor/DUI as a result of unemployment insurance overpayment/fraud. Any unpaid debt may have an impact on whether or not a candidate is offered employment.
SELECTION PROCESS
All information concerning the qualifications including any required documentation (diploma transcript certificate etc.) must submitted and received by the closing date. Information submitted after this date will not be considered. Applications that meet minimum and/or selective qualifications will be referred to the hiring unit for interview selection. Units will select those candidates most closely demonstrating the qualifications for the interview.
A resume and cover letter are strongly encouraged for this position. Please upload one Word or PDF file that includes your combined cover letter and resume using the Transcript upload function or via the JobAps Other tab.
EXAMINATION PROCESS
The assessment may consist of a rating of your education training and experience related to the requirements of the position. It is important that you provide complete and accurate information on your application.
BENEFITS
This is a full-time permanent position and eligible for full State benefits which includes:
- Flexible hours and hybrid teleworking
- Paid holidays 12-13 per year
- Generous paid leave package (annual sick personal and compensatory leave)
- State Pension (defined benefitplan)
- Tax-deferred supplemental retirement saving plans (401(k) and 457)
- Comprehensive subsidized health dental and prescription plans with little to no deductibles free generic prescriptions and free preventative health services
- Flexible Spending Accounts plans for Health Care and Daycare
- State Employees Credit Union
To leave more please click this link:STATE OF MARYLAND BENEFITS
FURTHER INSTRUCTIONS
Please contact for additional information concerning this recruitment. Online application are strongly preferred. A resume and cover letter are strongly encouraged for this position. Please upload on Word or PDF that includes your combined cover letter and resume using the Transcript upload function or via the JobAps Other tab.
U.S. Military Veterans may qualify for additional bonus points towards certification. Any job offer will be contingent on the candidate providing a U.S. military form DD214 verifying honorable discharge form services prior to starting employment (and may be requested prior to the interview). Permanent state employees do not need submit proof of veterans
If you are unable to apply or encounter difficulty attaching required or optional documentation you may submit via email to Please be sure to include your name identification number (Easy ID#) and job announcement number on any documentation to ensure timely processing.
PLEASE DO NOT FAX OR EMAIL UNSOLICITED DOCUMENTATION.
Completed application required documentation and required addendums may be mailed to
Maryland Department of Labor
Office of Administration
ATTN: Tiffany Lott-Mallard (26-)
100 S. Charles Street Suite 5000 Tower 1
Baltimore Maryland 21201
Required Experience:
Manager
Key Skills
- Vendor Management
- Fmla
- HIPAA
- Analysis Skills
- Benefits Administration
- HRIS
- Filing
- Payroll
- Employment & Labor Law
- ADP
- Human Resources
- Workday
