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DIRECTOR OF CLAIMS & BENEFITS

PROGRAM MANAGER SENIOR II

Recruitment #25-005483-0002

Introduction

The Division of Family and Medical Leave Insurance (FAMLI) is hiring a Director of Claims and Benefits to join our mission of making sure Maryland workers get paid when they need time to care for themselves and their families. FAMLI will provide job protection and partial wage-replacement to 2.8 million workers. The Claims & Benefits team is responsible for processing claims for benefits, adjudication of issues, reviewing medical certification, fraud detection and auditing claims for those that apply for paid leave. The Director of Claims & Benefits will build and lead the claims & benefits team, as well as serve as a subject matter expert within the division. We are committed to creating an organization that embraces modern best practices in everything we do. The Director of Claims & Benefits will be responsible for building and leading the team, and creating processes and procedures for examining, adjudication and reconsideration of paid leave claims; managing benefit overpayments, repayments, and payment plans; and identifying and investigating fraudulent claims. In addition to carrying out these essential functions, the Director of Claims and Benefits team will also provide excellent customer service, as well as gather and implement feedback in order to continuously improve the experience with FAMLI. Opportunities in state government to build new organizations from the ground up are rare, and FAMLI needs a uniquely qualified candidate for the Director of Claims & Benefits role. The ideal candidate will be is an experienced and strategic manager who will be a trusted thought-partner for FAMLI’s senior leaders; a capable and inspiring leader who can hire, guide, and motivate a high-powered team; and also a “builder” with the imagination, determination, and entrepreneurial outlook necessary to build something great.

This is a Management Service position that serves at the pleasure of the Appointing Authority.

GRADE

24

LOCATION OF POSITION

100 S. Charles Street
Baltimore, Maryland 21201

Main Purpose of Job

The Director of Claims and Benefits is a senior leader in the Division of Family and Medical Leave Insurance (FAMLI) at the Maryland Department of Labor (MD Labor). The Director of Claims and Benefits will set and execute the organizational strategy for FAMLI’s claims examination, claims management, and benefits functions. The Claims and Benefits Directorate will be responsible for examining FAMLI claims for accuracy; adjudication of potentially disqualifying issues; reconsideration of benefit denials; managing benefit overpayments, repayments, and payment plans; and identifying and investigating fraudulent claims. The Director will collaborate with the FAMLI Employer Services, Customer Care, Products, Community & Stakeholder Engagement, Strategic Communications, and Insurance Plan Compliance teams, as well as other members of the Maryland Department of Labor, to ensure that FAMLI examines claims and manages benefit payments in a timely, accurate, and fair way

POSITION DUTIES

Duties of this position include but are not limited to: 

● Decides the operational direction of FAMLI’s Claims and Benefits Directorate;
● Determines organizational structure and staffing needs of the Claims and Benefits Directorate; 
● Oversees hiring, onboarding, and training of Claims and Benefits staff;
● Establishes policies and procedures for the Directorate relating to adjudication, medical certification review, benefit payment, and fraud investigation; 
● Oversees policy and procedure implementation, evaluates the effectiveness of policies and procedures, and approves major revisions; 
● Establishes overall Directorate goals, standards, and controls to meet Directorate objectives and oversees their achievement; 
● Collaborates with other FAMLI Directorates to make and execute a plan for building out the Claims and Benefits Directorate; 
● Develops and oversees collection of qualitative and quantitative data to assess performance; 
● Plans, directs, and administers all aspects of the Claims and Benefits Directorate including claim review for state plan and private plans, claims adjudication, claims reconsideration, benefits payment management, and data review to ensure plan access across state and private plans;
● Oversees and manages the personnel and financial resources of the Directorate; 
● Develops, implements, and manages short and long-range plans for Claims and Benefits Directorate operations and resources; 
● Plans, coordinates, supervises, and evaluates the work of subordinate employees; 
● Prescribes and oversees development and training of Directorate staff; 
● Represents the Claims and Benefits Directorate before state officials, legislative committees, and senior managers and executives of other agencies concerning Directorate activities; 
● Performs other related leadership duties as required.

MINIMUM QUALIFICATIONS

Education: 
● Possession of a Bachelor’s degree from an accredited college or university 

Experience: 
At least ten (10) years of progressively responsible experience working and managing in complex organizations in the public, private, or non-profit sectors, including: 
● Leading dynamic, high-performance teams;
● Developing and executing short and long-range strategies to improve organizational effectiveness and efficiency; 
● Successfully managing relationships with demanding stakeholders in complex, high-stakes environments.

DESIRED OR PREFERRED QUALIFICATIONS

● Master’s degree in Public Administration, Business Administration, Public Policy, or other relevant field.
● Experience building and/or overseeing operations involving benefit payment.
● Track record of providing outstanding customer experience through data-driven, user-centered improvements to organizational processes and training.
● Experience building an organizational culture of empathy, empowerment, and relentlessly high-performance standards among stakeholder-facing staff. 

You’ll fit right in at FAMLI if:
● You value autonomy in your work, strive to achieve mastery in your field, and are energized by a mission-driven organization.
● You’re a strong and inclusive leader who loves helping staff grow to meet difficult challenges.
● You’re an excellent collaborator.
● You are excited about solving complex human and organizational issues.
● You’re an organized person who has experience coordinating complex projects.
● You’re great at delegating ownership to capable people. 

SPECIAL REQUIREMENTS

All candidates are subject to a background check against files maintained by the Division of Unemployment Insurance (Labor/DUI) to determine whether any monies are owed to Labor/DUI as a result of unemployment insurance overpayment/fraud. Any unpaid debt may have an impact on whether or not a candidate is offered employment.

SELECTION PROCESS

All information concerning the qualifications, including any required documentation (diploma, transcript, certificate, etc.) must be submitted and received by the closing date. Information submitted after this date will not be considered. Applications that meet minimum and/or selective qualifications will be referred to the hiring unit for interview selection. Units will select those candidates most closely demonstrating the qualifications for interview.

A resume and cover letter are strongly encouraged for this position. Please upload one Word or PDF file that includes your combined cover letter and resume using the “Transcript” upload function, or via the JobAps “Other” tab.

EXAMINATION PROCESS

The assessment may consist of a rating of your education, training, and experience related to the requirements of the position. It is important that you provide complete and accurate information on your application.

BENEFITS

This is a full-time, permanent position and eligible for full State benefits, which include:
● Flexible hours and hybrid teleworking
● Paid holidays 12-13 per year
● Generous paid leave package (annual, sick, personal and compensatory leave)
● State Pension ("defined benefit" plan)
● Tax-deferred supplemental retirement savings plans (401(k) and 457)
● Comprehensive, subsidized health, dental and prescription plans with little to no deductibles, free generic prescriptions, and free preventative health services
● Flexible Spending Account plans for Health Care and Daycare
● State Employees Credit Union

To learn more, please click this link: STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS

U.S. Military Veterans may qualify for additional bonus points towards certification. Any job offer will be contingent on the candidate providing a U.S. Military Form DD 214 verifying honorable discharge from service prior to starting employment (and may be requested prior to interview). Permanent state employees do not need to submit proof of veterans’ status.
If you are unable to apply online or encounter difficulty attaching required or optional documentation, you may submit via mail or deliver in person. Please be sure to include your name, identification number (Easy ID#) and job announcement number on any documentation to ensure timely processing.

PLEASE DO NOT FAX OR EMAIL UNSOLICITED DOCUMENTATION

Completed applications, required documentation, and any required addendums may be mailed to:

Maryland Department of Labor/Office of Administration
Attn: Erika Leonard-Anderson 25-005483-0002
100 S. Charles Street, 5th Floor
Baltimore, MD 21201

Please contact Erika.Leonard-Anderson1@maryland.gov for additional information concerning this recruitment. Online applications are strongly preferred. A resume and cover letter are strongly encouraged for this position. Please upload one Word or PDF file that includes your combined cover letter and resume using the “Transcript” upload function or via the JobAps “Other” tab.

The MD State Application Form can be found online.

The Maryland Department of Labor is an equal opportunity employer. It is the policy of LABOR that all persons have equal opportunity and access to employment opportunities, services, and facilities without regard to race, religion, color, sex, age, national origin or ancestry, marital status, parental status, sexual orientation, disability, or veteran status.



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