2121 K Street, NW
The United Mine Workers of America Health and Retirement Funds (the Funds) has an executive-level opening for Director, Operations and Eligibility Services. The Funds is a group of six multi-employer plans that provide health and pension benefits primarily to retired coal miners and their eligible dependents.
The Director of Operations and Eligibility Services is responsible for the administration of approximately $700 million in pension benefits that includes the timely and accurate processing of benefit applications, and over $500 million in medical and pharmacy claims. The incumbent will direct activities relating to the following:
· Determination of health and pension benefits
· Medical and drug claims administration
· Medical and drug care management
· Utilization review
· Leading contractor selection, and contract negotiations, with pharmacy benefit managers, claims administrators, and medical management vendors
· Provider network development and maintenance
· Beneficiary services in accordance with Board of Trustees and Executive Director directives
· Coordination with appropriate governmental agencies, consultants, contractors, and board members’ appointing parties
Bachelor’s degree or equivalent plus ten to fifteen years related experience and/or training, of which four to ten years should be managerial or supervisory; or equivalent combination of education and experience. Ability to read, analyze, and interpret the most complex documents. Must possess refined writing and presentation skills.
Requires in-depth knowledge in the following areas:
· Employee Retirement Income Security Act (ERISA)
· Centers for Medicare and Medicaid Services (CMS) and Medicare program requirements
· Insurance and managed care programs that relate to health care benefit claims administration and cost management initiatives
We offer an excellent benefits package, 35-hour workweek, 401(k) plan, pension, tuition reimbursement, and paid holidays. Complete background check required. Please send your resume and cover letter to:
UMWA Health & Retirement Funds
2121 K Street, NW, Suite 350
Washington, DC 20037
We offer an excellent benefits package, 35-hour workweek, 401(k) plan, pension, tuition reimbursement, and paid holidays.
Minimum Education Required