State of Maryland

A Claims & Benefits Specialist Manager is the managerial 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 Specialist Supervisors.

Employees in this classification receive general supervision from a higher-level 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 & Benefits Specialist Manager is differentiated from the Claims & Benefits Specialist Supervisor in that the Claims & Benefits Specialist Manager supervises lower-level Claims & Benefits Specialist Supervisors, while the Claims & Benefits Specialist Supervisor supervises lower-level Claims & Benefits Specialists under general supervision.

Plans, coordinates, and evaluates the daily operations and workflows of an assigned Claims & Benefits Specialist Supervisors;

Provides guidance to ensure quality assurance audits of claims determinations completed by subordinate staff, ensuring accuracy and regulatory compliance;

Evaluates operational problems and proposes solutions to higher-level management;

Contributes to the compilation of metrics information to report to leadership;

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

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

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.

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 recommendations;

Ability to work independently and as part of a team.

Class Descriptions 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.

Class Descriptions provide information about the Nature of Work, Examples of Work, General Requirements and Acknowledgements. The Required Knowledge, Skills, and Abilities; Minimum Education and Experience Requirements; Special Requirements; and recruitment and testing procedures are set by the using agency.

This is a Management Service classification in the State Personnel Management System. All positions in this classification are Management Service positions.

This classification is not assigned to a bargaining unit, as indicated by the designation of M (Manager), T (Agency Head), U (Board or Commission Member), W (Student), X (Used by Agency or Excluded by Executive Order), or Z (Confidential). As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded collective bargaining. Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.