Benefits Administration Manager – On-Site Health Plan Ops

Cow Creek Band of The Umpqua Tribe of Indians; Roseburg (OR); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Nesika Medical, Dental, Vision, Prescr

Short Term/Long Term Disability

401K – 7% Tribal Contribution

15K Life Insurance

Flexible Spending Account

Recuro Care

Employee Assistance Program

Fuel Discount Card

Costco Reimbursement

PTO

Years of Service Recognition

Job summary

The Cow Creek Band of Umpqua Tribe of Indians invites applications for the full-time Benefits Administration Manager position. This role leads the Nesika Health Plan operations, a self-funded and self-administered program serving employees and Tribal Members, located at our headquarters with no remote work option.

Responsibilities include supervising plan operations, eligibility, claims processing, vendor coordination, and ensuring HIPAA, ACA, COBRA, and ERISA compliance while partnering with

Qualifications

• Associates Degree or greater in a related field.
• Minimum five years of experience in employee benefits, health plan administration, or related field.
• At least two years of supervisory, lead, or management experience.
• Health and Life State License, or ability to obtain within 6 months of hire.
• Proficient in provider billing, medical coding, and utilization management.
• Strong skills with claims administration systems, eligibility systems, Office 365, and other relevant reporting tools.
• Excellent analytical and problem-solving abilities.
• Comprehensive knowledge of medical and prescription benefit terminology and claims processing.
• Current and valid Oregon Driver’s License with eligibility for the Cow Creek Government Office Driver’s Program.

Responsibilities

• Manage the daily operations of the self-funded, self-administered health plan and Tribal programs, supporting the Director of Benefits Administration and Risk Manager.
• Review complex or unusual benefit queries and make recommendations for appropriate plan administration.
• Interpret plan provisions and provide authoritative guidance on coverage, exclusions, limitations, and administrative requirements to staff, members, and leadership.
• Promote and ensure responsive, respectful and accurate service delivery to all stakeholders.
• Direct the administration of appeals, grievances, benefit inquiries, ensuring responses are timely, clear, and compliant with plan requirements.
• Establish and maintain quality control procedures including regular claim audits and corrective action protocols.
• Handle claim corrections, overpayment recoveries, refunds, and liaise with legal and financial teams on subrogation and third-party liability issues.
• Develop and disseminate clear, effective communications pertaining to member eligibility, benefits, claims, and any plan changes.
• Identify training needs and develop programs to enhance understanding of plan provisions and administrative procedures among staff.
• Monitor claim payments and administrative expenses to ensure proper authorization, documentation, and financial tracking.
• Assist with budgeting, forecasting, financial analysis and planning related to health plan management.
• Support compliance with all relevant healthcare regulations including HIPAA, ACA, COBRA, and ERISA.

Skills

provider billing

medical coding

utilization management

claims administration systems

eligibility systems

Office 365

reporting tools

Education

Associates Degree or greater in a related field

Job description

The Cow Creek Band of Umpqua Tribe of Indians invites applications for the full-time Benefits Administration Manager position. This role leads the Nesika Health Plan operations, a self-funded and self-administered program serving employees and Tribal Members, located at our headquarters with no remote work option.

Responsibilities include supervising plan operations, eligibility, claims processing, vendor coordination, and ensuring HIPAA, ACA, COBRA, and ERISA compliance while partnering with