Manager, Fund Administration

Amalgamated Life Insurance•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 oversees client subrogation activity.

Requirements

College degree preferred, or at least 5 years of experience.
Microsoft Office experience, including Word, Excel, and PowerPoint.
Ability to train and navigate through multiple internal computer systems.
High-level communication skills.
Willingness to take initiative and multitask across several duties and responsibilities.

Nice To Haves

College degree.

Responsibilities

Manage pharmacy benefits for multiple clients and account-manage the internal pharmacy benefits product.
For the CVS pharmacy benefit (ANHF), process weekly invoices; work with Case Managers on the Diabetic Management Program; update the CVS system manually; review and approve prior authorizations; handle special mailings for drug cards; coordinate annual Medicare D mailings for Local 99 and HMO and BCBS-MA members; troubleshoot weekly file issues; and interact with PBM consultants.
For the AEBRx pharmacy benefit, manage eligibility in ECI and sometimes Magellan; process bi-monthly Magellan invoices and payments; provide Finance with information for client invoices; provide requested reports to consultants and funds; and work with Magellan to address member prescription issues.
Manage Medicare Demands for all funds: review eligibility and claims, determine whether claims are already in the system or were paid as primary or secondary, coordinate claim entry when needed, print related EOBs, arrange checks for manual handling, compile documentation, and respond to CMS within the appropriate time frame with a valid reason for each unpaid claim.
Create and mail initial subrogation lien packages, obtain document numbers, and update ECI notes.
Handle attorney calls and respond by email, fax, or mail; provide relevant 5500 forms and copies of related claims and EOBs, electronically or on encrypted CD when needed.
Prepare benefits statements with lien information for attorneys or refer responses to Optum.
Review paid and unpaid claims related to accidents and identify claims that may need to be addressed before settlement.
Work with the subrogation vendor, Optum, including accessing its system for reporting and updating cases involving requested retractions.
Provide Finance with monthly recovery breakdowns, including deposit allocation and amounts, and provide Raj with report copies and breakdowns so refunds can be applied in Eldorado.
Coordinate with Claims to ensure claims are processed after documentation is received or after resolution work with attorneys.