Welcome to a team of caring and passionate people who work each day to meet the needs of our members and clients. At Health Benefits (a subsidiary of Health Care Service Corporation), you will be part of an organization committed to offering custom services to self-funded health benefits plans that manage costs – without compromising benefits – by offering innovative solutions, flexibility, transparency and customer support. This is an exciting time to join our team and enhance our culture that emphasizes caring, diversity and inclusion, mutual respect, collaboration and service to our communities.
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Summary: The Managed Care Specialist will primary be responsible for our Direct to Employer/Unique Opportunity clients; for all processes related to network administration including Medical RFP submission, new client implementation/ network investigation and network management to ensure flawless customer service to our clients.
Responsibilities include:
- Provide consultative expertise to Sales/Brokers/Clients for all lines of business during the RFP and sales process.
- Research and collaborate with network contacts to develop client solutions.
- Provide consultative expertise with Sales and Client Management staff for network analysis during the RFP and sales process.
- Provides RFP and renewal exhibits for prospective and current clients.
- Proactively address Provider Network set up to avoid potential issues: including oversight and approval of ID Card Production/ coordination of Eligibility Feeds/Network Notification
- Track and review financial results for these clients to be able to collaborate with Client Management on best network solutions
- Provides support in compiling, maintaining and interpretation of Network data.
- Investigate network issues within appropriate turn-around times
- Participate in Business Unit and EPMO projects representing the Managed Care Unit.
- Support TIC/NSA Managed Care activities
- Act as a backup to the Managed Care team for client and vendor support.
- Other duties as assigned.
Qualifications:
- Minimum 2 years managed care, PBM or comparable healthcare marketing experience or related college degree.
- An understanding and working knowledge of health insurance contracts and benefit provisions as well as full knowledge of insurance operation essential.
- Demonstrated exceptional technical skills in MS Office (Excel, Access, Word).
- Ability to adapt to a fast-paced, customer service driven environment requiring changing priorities,
- Ability to consistently meet deadlines and deliver high-quality information and recommendations.
- Exceptional organization and prioritization skills in order to address time sensitive assignments
- Strong written and oral communication skills.
- Ability to travel.
- Ability to work independently with little to no supervision.
- Attention to detail required and strong problem-solving skills.
- Ability to manage several projects concurrently.
- Must be able to handle confidential information.
At Health Benefits, you will be part of an organization committed to offering meaningful benefits to our associates to support their life outside of work. From health and wellness benefits, 401(k) savings plan, a minimum of 15 days of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, new parent paid leave, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time associates.
The compensation range for this position is between $47,267.00 and $88,754.00. The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan.
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran or disability.
Required Skills
Required Experience
