Our client is looking for a DIRECTOR OF BENEFITS ADMINISTRATION located in Metro Detroit.
SUMMARY
Our client is a highly respected, mission-driven organization based in Metro Detroit, known for its exceptional employee programs and long-standing commitment to serving its members. They re seeking a dynamic and experienced Director of Benefits Administration to lead and elevate a multi-functional team that supports thousands of participants. This is a key executive role reporting directly to the Executive Director and playing a strategic role on the leadership team.
ESSENTIAL DUTIES & RESPONSIBILITIES
This is a high-impact position overseeing the full spectrum of health and welfare benefit operations from claims and appeals to system oversight and member service. You ll lead cross-functional teams, drive process improvements, ensure compliance, and make meaningful contributions to the overall success of the Fund.
Claims Processing: Lead a high-performing claims team, ensuring timely and accurate processing aligned with DOL and BCBSM standards. Leverage your expertise in plan documents (SPD) and collaborate closely with BCBS through regular partnership meetings.
Quality Assurance: Partner with internal auditors to identify training opportunities and improve audit accuracy. Drive continuous improvement and policy development for better outcomes and team performance.
Call Center (Member Services): Help shape the member experience by partnering with the Call Center Manager to meet key performance goals, enhance communication workflows, and improve participant satisfaction.
Appeals: Oversee the appeals process from start to finish, ensuring thorough research, timely responses, and well-prepared presentations to the Board of Trustees. Serve as a voting member of the Appeals Committee.
Utilization Review: Manage medical review processes in collaboration with the Utilization Coordinator and Medical Director. Ensure timely decisions and thoughtful coverage assessments, even outside of standard reviews.
System Administration: Act as a key liaison between operations and IT to ensure benefit plans are properly configured in the basys system. Participate in weekly and monthly system strategy meetings to troubleshoot, optimize, and drive innovation.
Account Services: Oversee eligibility, COBRA, contributions, retiree processing, and mailroom functions. Ensure accuracy, compliance, and seamless collaboration with internal and external partners.
EDUCATION & EXPERIENCE
Strong background in employee benefits and health plan administration, ideally within a union or multi-employer environment.
Deep knowledge of medical claims, Medicare coordination, COBRA regulations, and eligibility management.
Bachelor s degree required; CEBS or similar credential preferred.
Demonstrated leadership experience with multi-disciplinary teams and third-party partners (e.g., BCBSM, basys).
If you are a high performer and would like to work for an equally high performing company and you think the above opportunity is appropriate for you, we invite you to apply to this job and email your resume to aparish@venteon.com.
We treat all resumes with strict confidentiality. We will always contact you first before submitting your resume to our client(s) for review. If you do not receive correspondence, you are not a fit for this position.
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