Manager, Fund Administration

Amalgamated Life•White Plains, NY

About The Position

Amalgamated Employee Benefits Administrators (AEBA) provides third-party benefit administration, including pension, medical, collections, and billing services, to self-insured clients. The Manager of Fund Administration manages pharmacy benefits for multiple clients and account-manages pharmacy benefits for AEBA’s internal pharmacy benefits product. The role also works with the Claims Department to manage Medicare Demands, including daily communications with CMS, and manages client subrogation activity. Subrogation work includes attorney communications, coordinating with the subrogation vendor, creating and mailing lien packages, and coordinating with the Claims Department to ensure claims are processed.

Requirements

A college degree is preferred, or at least five years of experience is required.
Experience with Microsoft Office, including Word, Excel, and PowerPoint.
Ability to train on and navigate multiple internal computer systems.
Strong communication skills.
Willingness to take initiative and multitask across several duties and responsibilities.

Nice To Haves

A college degree.

Responsibilities

Process weekly invoices for the CVS Pharmacy Benefit (ANHF).
Coordinate the Diabetic Management Program with Case Managers.
Make manual updates in the CVS system.
Review and approve prior authorizations.
Arrange special mailings of drug cards.
Handle annual Medicare D mailings, including for Local 99 and HMO and BCBS-MA members.
Troubleshoot issues with the weekly file.
Interact with PBM consultants.
Enter manual eligibility for AEBRx in ECI and, sometimes, Magellan.
Process bi-monthly invoices and payments to Magellan, and provide Finance with information for client invoices.
Provide requested reports to consultants and funds.
Work with Magellan on member prescription issues.
Respond to Medicare Demands for all funds by reviewing eligibility and claims, determining whether claims are already in the system or have been paid as primary or secondary, and coordinating claim entry when needed.
Print related EOBs, arrange manual handling of checks for payment, compile documentation, and respond to CMS within the appropriate timeframe.
Address each claim in Medicare Demand responses with a valid reason when payment is not made.
Create and mail initial subrogation lien packages, obtain document numbers, and update ECI notes.
Handle attorney calls and respond to attorneys by email, fax, or mail.
Provide relevant Fund 5500 Forms and create PDF copies of related claims and EOBs for electronic delivery or, when necessary, encrypted CDs.
Prepare benefits statements with lien information for attorneys or refer responses to Optum.
Review paid claims in member histories that appear related to accidents and review unpaid claims that may need to be addressed before settlement.
Coordinate with Optum, the subrogation vendor, and access its system for reporting and updating cases when retractions are requested.
Provide Finance with monthly recovery breakdowns, including deposit destination and amounts, and provide Raj with the report and breakdown so refunds can be applied in Eldorado.
Work with Claims to ensure claims are processed after documentation is received or after resolution is reached with an attorney.