Join the APWU Health Plan team

Claims Supervisor

APWU Health Plan, a non-profit organization located in Glen Burnie, MD, is seeking an Enrollment Supervisor to join our Claims Department.

The Claims Supervisor is responsible for managing the claims inventory and resources through timely and accurate processing of higher-level claims and to manage the processing of claims adjustments through the correction of processing error and handling overpayments or underpayments.

RESPONSIBILITIES

• Meet given objectives to cycle time, QA and productivity.
• Operate within the unit administrative budget.
• Manage unit workflow and inventory.
• Manage reporting of daily/monthly – Adhoc of the unit.
• Update standards and write/update unit procedures on a timely basis.
• Administer Plan personnel policies/CBA accurately and equitably.
• Complete assignments in a timely manner.
• Initiate IT tickets for system issues.
• Respond to other departments’ inquiries timely.
• Train staff as needed.
• Other duties as assigned.

REQUIREMENTS

• AA degree (or commensurate experience) preferred.
• Minimum of 3 years claims experience.
• Minimum of 3 years of experience in a supervisory position.
• Must have QNXT processing experience.
• Decision-making and problem-solving skills.
• Ability to prioritize, organize tasks and develop the necessary action plans to accomplish specific goals within required deadlines.
• Motivational/leadership skills.
• Good verbal and written communication skills.
• Self-motivated and ability to take initiative.

We offer a competitive salary; health, dental, & vision insurance; 401(k); generous vacation leave; and tuition reimbursement. Please ensure all of the above requirements are clearly reflected in your resume or specifically addressed in your cover letter. Stated salary requirements (range is acceptable) are required for consideration. Experience in a Union environment preferred. No relocation assistance available. Must pass criminal records check and drug screening prior to employment.

Apply Now

EOE M/F/D/V; Drug-Free Employer

Utilization Analyst

APWU Health Plan is seeking a Utilization Analyst to join our Utilization Management Department. This position assures the Health Plan remains competitive by identifying, designing, recommending, implementing and evaluating healthcare programs that control utilization and benefit expense.

RESPONSIBILITIES

• Identify and seek out potential programs and vendors that support utilization management and make recommendations to senior staff on initiatives and strategies that support the corporate mission.
• Advise on industry trends and identifie the need for new or revised utilization management programs and practices.
• Direct quarterly trend reviews and forecasting analysis.
• Other duties as assigned.

REQUIREMENTS

• BA/BS degree and three to five year’s health insurance experience.
• LPN or RN certification preferred.
• Ability to define data and information needs; compile, analyze and interpret data relative to healthcare utilization.
• Ability to write reports, recommendations, business correspondence, scope of work, project plans, policies and procedures. Ability to effectively present information to Health Plan Management and effectively communicate with vendor/partners and members.
• Experience with medical benefit management and plan design, pharmacy benefit management and plan design, medical coding, medical and behavioral case management, familiarity with medical and pharmaceutical policies and industry standards.
• Detail-oriented with strong analytical, presentation and research skills a must.
• Strong performance management skills in managing external partners, communicating clear goals, performance measurements, etc.
• Demonstrated ability to identify problems, collect data from various sources and determine the appropriate action.
• Multi-disciplinary project management skills.
• Excellent computer skills to include Microsoft Office, internet research and Ad hoc query and reporting.

We offer a competitive salary; health, dental, & vision insurance; 401(k); generous vacation leave; and tuition reimbursement. Please ensure all of the above requirements are clearly reflected in your resume or specifically addressed in your cover letter. Stated salary requirements (range is acceptable) are required for consideration. Experience in a Union environment preferred. No relocation assistance available. Must be COVID-19 vaccinated, pass criminal records check and drug screening prior to employment.

Apply Now

EOE M/F/D/V; Drug-Free Employer