Winston Staffing Services
Job Description
Coordinate retiree Health & Welfare benefits eligibility and enrollment with the Pension Department, including Horizon BCBS, Express Scripts, and accurate updates to AS400, GIBS, and related systems. Manage the Funds Bronze Plan and annual Open Enrollment, ensuring eligibility, deductions, effective dates, and ongoing coordination with corporate offices. Handle insurance claims support, including life insurance claims processing and facilitation of 2nd- and 3rd-level medical and prescription drug appeals with vendors, trustees, and external review organizations. Ensure accurate participant eligibility, enrollment, and data integrity across third‑party vendors, including employment status verification, LOA tracking, and return‑to‑work updates. Provide comprehensive retiree and participant support by responding to benefit inquiries, claims forms requests, address changes, ID card issues, COBRA overflow, and coverage verification. Maintain compliance with regulatory requirements, including Creditable Coverage Notices, Plan Documents, SPDs, SMMs, and Medicare‑related reporting (e.g., 1095‑B corrections). Generate and coordinate required data for annual valuation reporting, Summary Annual Report (SAR) preparation, and mailings. Collaborate with Health & Welfare leadership, Fund Counsel, and Trustees to implement benefit program changes driven by collective bargaining, legislative, regulatory, or vendor updates.
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Coordinate retiree Health & Welfare benefits eligibility and enrollment with the Pension Department, including Horizon BCBS, Express Scripts, and accurate updates to AS400, GIBS, and related systems. Manage the Funds Bronze Plan and annual Open Enrollment, ensuring eligibility, deductions, effective dates, and ongoing coordination with corporate offices. Handle insurance claims support, including life insurance claims processing and facilitation of 2nd- and 3rd-level medical and prescription drug appeals with vendors, trustees, and external review organizations. Ensure accurate participant eligibility, enrollment, and data integrity across third‑party vendors, including employment status verification, LOA tracking, and return‑to‑work updates. Provide comprehensive retiree and participant support by responding to benefit inquiries, claims forms requests, address changes, ID card issues, COBRA overflow, and coverage verification. Maintain compliance with regulatory requirements, including Creditable Coverage Notices, Plan Documents, SPDs, SMMs, and Medicare‑related reporting (e.g., 1095‑B corrections). Generate and coordinate required data for annual valuation reporting, Summary Annual Report (SAR) preparation, and mailings. Collaborate with Health & Welfare leadership, Fund Counsel, and Trustees to implement benefit program changes driven by collective bargaining, legislative, regulatory, or vendor updates.
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