Job Summary

This position is responsible for creating, managing and reporting processes designed to monitor and evaluate activities and functions delegated to contracted, delegated entities and vendors for assigned products and business lines according to all corporate and regulatory/accreditation requirements and standards. This person will also monitor timeliness of all claims, accuracy of payments and denial ratios, as well as quarterly and annual financial accuracy audits. Ability to travel (as business need arises; within assigned territory; less than 10%).

Required Job Qualifications:

• Bachelor's degree in Business or Medical OR 4 or more years' experience in a managed care environment.
• 4 years in a leadership role that includes direct accountability and responsibility and direction of staff.
• 4 years' experience in directly performing delegated oversight activities.
• Project Management skills and experience.
• Knowledge of regulatory/accreditation requirements and standards (TDI, NCQA, URAC).
• Verbal and written communication skills.
• Organizational skills and the ability to handle multiple priorities.
• PC proficiency to include Word, Excel, PowerPoint and Lotus Notes.
• Ability to travel.

Preferred Job Qualifications:

• Knowledge of Power Point and Visio.
• Customer service experience (call scripts, call metrics, identify callers for PHI security, resolving inquiries, protocol adherence, etc).
• Tele-sales experience (State Department of Insurance regulations adherence).
• Polished and professional email and phone etiquette; customer service minded
• Ability to work under strict regulations and timelines
• Ability to navigate multiple projects with varying deadlines

Sponsorship will not be provided for this role.

This is a Telecommute (Remote) role.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Base Pay Range
$55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location.