Claims and Benefits Manager

State of Maryland • Baltimore City, MD

8d • Hybrid

About The Position

Maryland's 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 180,000 employers, delivered as a digitally native, public-facing services. We're 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. 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 FAMLI’s mission to ensure working Marylanders can afford to take time off to care for their loved ones and themselves.

Requirements

• Education: A Bachelor's degree from an accredited college or university.
• 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.

Nice To Haves

• Advanced Degree or Master's 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.

Responsibilities

• 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)

Benefits

• Flexible hours and hybrid teleworking
• Paid holidays 12-13 per year
• Generous paid leave package (annual, sick, personal and compensatory leave)
• State Pension ("defined benefit"plan)
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Manager