Qureos Mentor

Black Oak Casino

<div>Position Summary: Under the general direction of the Benefits Director, the Benefits Project Leader researches, analyzes, evaluates, audits, and supports key projects. Manages the payment of benefit program expenses for the CCM&rsquo;s/Employees of the Tuolumne Me-Wuk Tribal Council and all entities of the Tribe. This position will support consistent and effective administration of benefit plans. Function as point of contact as designated by the Benefits Director.
Duties and Responsibilities:<ul><li>
Understands, complies, and interprets current employee benefit plan CCM&rsquo;s/Employees market trends/conditions, programs, healthcare data analytics, plan administration, legislative requirements and filing of federal and state forms that relate to CCM&rsquo;s/Employee benefit plans. Recommends and assists with the design and development of benefits programs and policies. Complies and interprets data related to benefits activity. Makes recommendations for plan changes and improvements based on quantitative modeling and analysis.
</li><li>Working knowledge of healthcare industry and provider of services terminology, pharmacy benefit management and general knowledge of medical terms and forms.
</li><li>Research the legal and regulatory compliance issues of benefits and recommends optional action plans to ensure plan compliance.
</li><li>Prepare data analysis reports that support Plan Sponsor compliance with federal/state laws and regulations including, but not limited to IRS, DOL, COBRA, FML, HIPAA, ACA, ERISA, and Plan Fiduciary responsibilities. Collect experience data from available resources.
</li><li>Manages the payment and accounting allocation of benefit program expenses in collaboration with HR/Payroll/Risk/Benefit systems and third-party administrators/service providers.
</li><li>Will perform data audits to ensure accuracy, quality, and plan compliance. Assists in identifying opportunities to streamline processes and implement efficiencies.
</li><li>Determines and manages the coordination to track CCM&rsquo;s/Employees impacted by various plan design changes to benefits and/or CCM&rsquo;s/Employees eligibility criteria.</li><li>
Responsible for reporting, eligibility, compliance, data testing support.
</li><li>Researches, compiles, analyzes, and summarizes data for routine and/or special projects or reports.
</li><li>Acts as subject matter expert advising on benefits related matters.
</li><li>Project Lead Coordinator for annual open enrollment process/scheduling, including SBCs, Benefits Guidebook, posters, mailings, rate changes, implementation of plan changes within the HRIS system, and other elements of Open Enrollment. Assists with development of benefit communication materials in coordination with internal and external resources to support promotion of benefits value. Ensures that all benefits are effectively communicated to CCM&rsquo;s/Employees to ensure education regarding changes and timely processing of CCM&rsquo;s/Employee elections in all divisions of the Tribe.
</li><li>Participates as a key staff member on Special Projects to develop, manage, research, create, establish, schedule timelines, budget and implement to ensure achievement of goals and tactical business results.
</li><li>Coordinates all projects for Benefits Committee.</li><li>
Coordinates all annual Benefits Fair.</li><li>
Manages Community Council Members benefits. CCM provider billing and CCM Medicare enrollment/coordination of Covered California. Works closely with PRC to ensure Medicare Like Rates (MLR) for CCM&rsquo;s large dollar savings. Implementation and coordination of Medicare as primary insurance.</li><li>
Performs other job duties as assigned.
</li></ul><ul><li>Minimum of seven (7) to ten (10) years in benefits administration in public or private sector with at least three (3) years in a role like the job duties and responsibilities specified above.</li><li>
Experience may be in private or government sectors and highly prefer candidate who has worked in a benefits environment with employee base of at least 500+ employees.</li><li>
Experience working directly with contracted service providers including benefit consultants, insurance companies, benefit eligibility organization, plan auditors, TPAs and internal and external stakeholders.
</li><li>Highly prefer bachelor&rsquo;s degree in related field.</li><li>
Ability to communicate effectively in both written and verbal communications.
</li><li>Familiarity in working with databases, excel spreadsheets, presentation software, and Word.</li><li>
Must be service oriented, demonstrate important level of accuracy, be meticulous without losing sight of the strategic objectives of the organization and work well with other people both internally and externally.</li></ul>
Physical Requirements:
This position requires walking, standing and sitting for prolonged periods of time; climbing stairs, stooping, kneeling, crouching , and reaching&rsquo; pushing, pulling and lifting up to 30 pounds, raising objects overhead; manual dexterity for operation of computer, phones and small office machines&rsquo; hearing, talking and good verbal and written communication skills&rsquo; repetitive motions of the wrist, hands and fingers.
Indian Preference:
Preference in filling vacancies shall be given first to qualified Tuolumne Me-Wuk Community Council Members and then to enrolled Native Americans of any federally recognized tribe. Documentation for claiming Native preference must be provided with the application for consideration. Other than the above, the Tuolumne Me-Wuk Tribe is an equal opportunity employer.
Pre-employment Requirements:
Employment is contingent on pre-employment background and drug test results</div>

Benefits Project Leader/CCM Specialist

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Benefits Project Leader/CCM Specialist