State of Maryland

A Claims & Benefits Supervisor is the supervisory level of work planning, coordinating, and evaluating the operations of an assigned unit of claims processing personnel within the Division of Family and Medical Leave Insurance (FAMLI), Maryland Department of Labor. Employees in this classification supervise lower-level Claims & Benefits Specialists.

Employees in this classification receive general supervision from a Claims & Benefits Manager or other designated program administrator.

Position placement in this classification is determined by the Classification Job Evaluation Methodology. The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of a classification specification.

The Claims and Benefits Specialist Supervisor is differentiated from the Claims and Benefits Specialist IV in that the Claims and Benefits Specialist Supervisor supervises lower-level Claims & Benefits Specialists, while the Claims and Benefits Specialist IV assigns, reviews, and approves the work of and trains lower-level Claims and Benefits Specialists, or is assigned the most complex job duties. The Claims and Benefits Specialist Supervisor is differentiated from the Claims and Benefits Specialist Manager in that the Claims and Benefits Specialist Manager supervises Claims & Benefits Specialist Supervisors.

Plans, coordinates, and evaluates the daily operations and workflows of an assigned claims and benefits unit;

Conducts quality assurance audits on claims determinations completed by subordinate staff to ensure accuracy and regulatory compliance;

Trains lower-level staff in application procedures, statutory updates, and system operations;

Resolves highly complex, sensitive, or escalated claims inquiries and customer gridlocks;

Reviews accuracy of and resolves issues with claims and/or benefits issuance;

Analyzes claims to recommend eligibility using knowledge of program policies, procedures, and regulations;

Researches and gathers information for outstanding issues on claims and/or benefits issuance;

Conducts fact-finding interviews with claimants and other stakeholders;

Identifies potentially disqualifying issues in claimants’ benefits eligibility;

Escalates questionable and/or fraudulent claims;

Addresses and researches customer concerns involving claims and benefits escalated from the Customer Care team;

May perform claims intake and processing;

May coordinate or assist with referrals for claim overpayments, reconsiderations, and appeals;

May assist the Customer Care team by answering phone calls, emails, and/or chats from claimants and employers;

Performs other related duties.

Thorough knowledge of State family and medical leave laws, rules, and regulations;

Skill in planning, coordinating, supervising, and evaluating the daily workflows of an operational unit to achieve agency performance metrics;

Skill in communicating effectively with a diverse range of clients both verbally and in writing;

Skill in the use of standard office equipment, such as photocopiers, calculators, personal computers, and printers;

Skill in delivering comprehensive training and technical guidance to subordinate personnel regarding evolving operational procedures and statutory mandates;

Ability to exercise sound and impartial judgment in analyzing facts and evidence, evaluating such information, and drawing valid conclusions from documentary evidence in making sound decisions;

Ability to establish and maintain effective and harmonious working relationships with subordinate staff, the general public, employers, healthcare professionals, and co-workers;

Ability to organize daily work plans;

Ability to learn and apply new computer applications and computer systems;

Ability to apply State family and medical leave laws, rules, and regulations and make appropriate determinations;

Ability to plan, coordinate, supervise and evaluate lower-level Claims and Benefits Specialist;

Ability to work independently and as part of a team.

Education: Graduation from an accredited high school or possession of a high school equivalency certificate.

Experience: Ten years of experience in public contact, including explaining information, gathering and compiling data, performing analysis of data, or completing general administrative tasks.

Notes:

1. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and six years of public contact, including explaining information, gathering and compiling data, performing analysis of data, or completing general administrative tasks, for the required experience.

2. Candidates may substitute additional college education at an accredited college or university at the rate of thirty (30) credit hours for one (1) year of the required experience.

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System. All positions in this classification are Skilled Service positions. Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is assigned to Bargaining Unit S, Supervisor. As provided by State Personnel and Pensions Article 3-102, special appointment, temporary, contractual, managerial, and confidential employees are exempt from collective bargaining. Additionally, certain executive branch agencies are exempt from collective bargaining, and all positions in those agencies are excluded from collective bargaining.