About the Company:
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).
The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.
Assist with all vendor activity, including but not limited to dental, ancillary, pharmacy and vision vendors for the Health Plan
Assist with vendor utilization including work flows for coordinating services with the Health Plan
Analyze vendor data and complete required reports for the health plan, Corporate and state
Perform as a key account manager for the Health Plan to coordinate with high priority providers and vendors
Coordinate with Medical Management, Member Services and Provider Services to educate and communicate expectations, performance and procedures to vendors
Respond to provider related database information requests and concerns
Ensure operation integrity, including compliance with all policies and procedures for the Health Plan including adherence to state contract and guidelines
Request and/or assist in the development of correction action plans for standards that are not met by the vendor
Serve as a point of contact and resource for the business unit and vendors for all credentialing inquiries and issues
Ensure compliance with NCQA, URAC, federal, state and payor standards
Bachelor's’ degree in Public Health, Business, related field or equivalent experience.
3+ years of healthcare management experience, preferably in vendor managed care or the health insurance field.
Experience with reporting and analyzing data preferred.
Strong Excel skills and working with a variety of software data programs preferred.
Project management experience is a plus.
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
Short- and long-term disability insurance
Basic Life insurance
Supplemental life insurance
401(k) retirement with company match
Employee stock purchase plan
Vacation, Personal and Sick time
Paid Company Holidays
Employee Assistance Program (EAP)
Training and Learning Opportunities
Tuition Reimbursement/Educational Assistance
On-site fitness center or discount at local fitness centers (most locations)
Discounts for select local and national products and services, including cell phones, computers and more
Other amenities may be available, but vary by location