Position Highlights:

Bilingual Spanish Fluency candidates only
Full-time, hybrid position
Location: Los Angeles, CA
Salary: $66,560-$90,000 annually, flexible for commensurate skills and experience; generous benefits package
An exciting opportunity for growth, and to join a growing organization, and launch a new benefits plan administration/operations team
Ability to positively impact the health and well-being of critical communities

Organization Overview:

Our Los Angeles-based client, the Santa Monica Fund (the “Fund”), is a start-up, non-profit Taft-Hartley Trust Fund passionate about its mission to provide exemplary services in healthcare and benefits administration to its UNITE HERE! union members and their families. The Fund, through its strategic partnership with MLK Community Healthcare, is staffing and opening a new clinic and office in downtown Los Angeles to offer primary care and dental services, side-by-side with benefits administration and support, for planned expansion in the future. The Fund takes pride in their commitment to providing excellent, affordable healthcare benefits to its members while ensuring member satisfaction, operational efficiency, and compliance. The team values diversity, equity, inclusion, and justice (DEIJ), fostering a safe, collaborative workplace where everyone can thrive. If you're passionate about growth, making a meaningful impact, and driving positive change, join their mission to support their community's well-being.

Position Overview:

Provides confidential, highly responsive and accountable, hands-on management of the day-to-day operations of SMF Member Services, including member-related planning, programs, education, and legal compliance. Acts as the representative to participating members for member-related matters, including researching and resolving questions and issues, as well as communicating and educating on health plan participation, reporting, compliance, standards, and benefits. Manages the staff and functions of Member Services, including the full spectrum of general and complex administrative and operational activities, key stakeholders and relevant 3rd-party administrators and vendors, and other SMF functional areas (as warranted) to fully utilize benefits in compliance with plan documents and with the best healthcare value, while optimizing the member’s experience. Manages initiatives and projects related to member services and organizational growth. Assumes primary accountability for planning and directing actions and initiatives to improve and sustain operational efficiency and effectiveness, and reduce costs (as warranted).

What You Will Be Responsible For:

Member Services

Proactively establishes and maintains collaborative partnerships and working relationships with participating members, employers, and union leadership (as warranted).
Supports planning for and onboarding new participating members and partners with Employer Services, Health Promotion, and Outreach on related activities for plan participants.
Acts as the primary contact for members, employers, union, providers, and vendors on benefits, claims, and eligibility, including support for telephonic and walk-in inquiries.
Performs enrollment functions, including telephonic and in-person outreach.
Encourages members to take steps to participate in healthcare programs.
Proactively manages, monitors, and reports on operational responsibilities (e.g., plan benefits, enrollment, member accounts, data management, compliance, reporting, audits, etc.) to ensure that the day-to-day business is operating at the required levels of quality, quantity, and accuracy.
Conducts research and root-cause analysis to identify gaps and discrepancies, and offers solutions to resolve issues.
Maintains and reviews databases, information systems, programs, processes, policies, procedures, vendor feeds, and forms/documents to ensure compliance and clarity. Makes recommendations for process, operational, and program improvements and enhancements to improve the quality and services delivered.
Ensures member communications and required notices and filings are completed with proper internal reviews and approvals, and submitted and/or distributed in a timely, compliant manner.
Supports compliance with applicable health plan federal, state, and local regulations and standards (e.g., ACA, HIPAA, COBRA, QMCSO, SBC, notifications, communications, etc.).
Partners with Employer Services and the technical team to ensure the operational efficiency and effectiveness of the software platform for plan benefits, member eligibility, data management, reporting, etc.
Ensures participant, dependent, and employer demographic data are up-to-date and accurate.
Partners with Employer Services to ensure that policies and procedures are in place that provide reasonable assurance that member eligibility is calculated correctly for plan participants and their dependents in accordance with plan documents.
Ensures that health plan-eligible participants and their dependents receive timely benefit coverage.
Ensures efficient and effective processes and procedures to enable employers, participants, and the union will receive the highest level of service by providing accurate, consistent, and timely answers to inquiries through a problem-solving and results-based approach.
Establishes, monitors, and takes action on performance standards, reporting, and compliance, including: develops and monitors policies, programs, and procedures; supports the management and resolution of appeals, issues, and complaints; ensures and optimizes member support and satisfaction; reviews systems, programs, processes, policies, procedures, and forms/documents to ensure compliance and clarity; makes recommendations for process/operational improvements to improve the quality and services delivered to participants and beneficiaries; ensures that all participant communications and required notices are completed and distributed in a timely, compliant manner; and evaluates overall performance by gathering, analyzing, interpreting, and reporting data and metrics with recommendations/solutions
Leadership: manages the Member Services staff (e.g., representatives and specialists); recruits, hires, trains, coaches, and evaluates Member Services staff by providing vision, leadership, guidance, and motivation through goal-setting and measurement and timely, constructive feedback.
Board of Trustee Meetings; helps develop relevant agendas and materials for meetings; works with Trustees and plan professionals to prepare and distribute reports and materials for meetings; monitors deliverables.
Actively contributes to developing and implementing the short- and long-term strategic, operational, and administrative goals of SMF.
Negotiates and manages relationships and service agreements with external partners and vendors.
Travel may be required from time to time.

What You Bring to the Role:

Years of Experience and Working Knowledge

Require 7+ years of demonstrated, increased responsibility and direct experience in and working knowledge of performing customer services, call center, and related administrative and operational duties in healthcare, insurance, union and/or community engagement environments.
Require 3+ years of demonstrated, increased responsibility and direct experience in managing staff and functional areas.
Require 2+ years of demonstrated, increased responsibility and direct experience in and working knowledge of health plan operations, administrations and compliance, including member enrollment, claims payment, and data management, auditing, and reporting.
Require 2+ years of demonstrated, increased responsibility and direct experience in and working knowledge of a call center environment and related software solutions for customer care and services.
Strongly prefer 3+ years of experience in customer care and services, including outreach activities.
Strongly prefer 3+ years of experience in project management in a growth-oriented environment.
Strongly prefer experience in and extensive knowledge of employee benefit plans and related governmental/legislative regulations (ERISA, DOL, IRC, HIPAA, ACA, etc.), including plan design and interpretation.
Strongly prefer advanced experience in Board-level participation and scheduling for large meetings, preparing and distributing meeting agendas and materials, creating and distributing reports, generating and managing meeting correspondence.
Strongly prefer advanced experience in software and database systems, practices, and tools, including creating and managing efficient document filing systems and file-sharing across multiple teams.
Prefer experience in Taft-Hartley or collective-bargaining environment.

Education, Licenses, and Certifications

Require a Bachelor’s degree in healthcare or business administration, or related field, or equivalent work experience.
Required Bilingual Spanish Fluency
Prefer customer service and healthcare experience and/or certifications.
Prefer project management-related experience and/or certification.
Prefer Six Sigma-related experience and/or certification.

Compensation, Benefits, and Job Structure:

Direct compensation range is $66,560-$90,000 annually, flexible for commensurate skills and experience. Also includes a comprehensive, generous benefits package ($36,175 value), including eligibility from the 1st of the month following 30 calendar days of active service, $0 co-premium, medical, dental, vision, prescription, 401(k), pension, life, and AD&D insurances, paid time-off (12.5 holidays, 3 personal days, 7 sick days, 5 bereavement days), vacation, legal services, and employee assistance program.