All the benefits and perks you need for you and your family: - Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
- Paid Time Off from Day One
- 403-B Retirement Plan
- 4 Weeks 100% Paid Parental Leave
- Career Development
- Whole Person Well-being Resources
- Mental Health Resources and Support
- Pet Benefits
Schedule: Full time
Shift: Day (United States of America)
Address: 2600 LUCIEN WAY
City: MAITLAND
State: Florida
Postal Code: 32751
Job Description:Facilitates work teams, tracks deliverables, and resolves issues for operational management of accounts, products, or programs. Develops and manages effective primary relationships with key stakeholders, supports professional negotiation, and ensures responsive communication and problem resolution to meet customer expectations. Acts as liaison between PHSO departments and customers to understand concerns, initiate plan improvements, and implement corrective action plans. Gathers underwriting data, reviews claims experience, and prepares summaries justifying renewal actions and recommending changes. Reviews contract provisions and administrative issues with leadership to pursue opportunities for improved profitability and retention. Reviews proposal requests, provides information to leadership, and assists in presenting proposals to Health Plans or Employers. Supports provider reps and negotiation teams in the acquisition, submission, and implementation of accounts, and joint product development for various products. Leads and coordinates the submission, setup, and implementation of assigned new populations with PHSO teams. Partners with Health Plans to facilitate the enrollment process, including preparation of materials and conducting meetings. Serves as mentor and liaison with all service lines offered by PHSO. Supports company initiatives by implementing changes and participating in project work. Educates PHSO teams on strategies and operations of new business. Performs other duties as assigned.
Knowledge, Skills, and Abilities: - Effective computer skills, particularly Microsoft Office Outlook, Word, Excel [Required]
- Ability to work in a matrix-management environment to achieve organizational goals [Required]
- Basic knowledge of all aspects of typical health plan operations including customer service, network management, data exchange, claims processing, sales and underwriting, marketing, benefit plan design, medical management, finance, risk adjustment, regulatory oversight, and compliance. Advanced knowledge in at least two of these fields. [Required]
- Knowledge of the health insurance/managed care industry including products (commercial large and small group, individual, Medicare Advantage, self-funded), market segments, competitive landscape, and applicable state and federal statutes and regulations. [Required]
- Excellent analytical, reasoning, problem solving, prioritization and business judgement. [Required]
- Excellent verbal and written communication ability, including preparation of presentations and collateral materials, with the ability to articulate complex information in understandable terms to all levels of staff. [Required]
- High-level interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams across department lines, management levels, and business entities. [Required]
- High degree of emotional intelligence and self-management ability. Able to remain calm, focused, and productive in stressful situations, conflicts. Able to manage uncertainty and shifting priorities. [Required]
- Excellent organizational, planning and time management skills. Able to understand complexity of and manage projects with multiple dependencies. [Required]
- Strategic development and marketing skills. [Required]
- Understanding of sales opportunities and ability to lead a client relationship with employers or brokers. This includes developing relationships, identifying client needs, designing (with others) solutions, and providing oversight and follow up as necessary. [Required]
- Working knowledge of Microsoft PowerPoint [Preferred]
Education: - Bachelor's [Required]
- Master's [Preferred]
Field of Study: - Healthcare Administration, business, or other related field to education
Work Experience: - 3+ in the field of health insurance (with an hmo, health insurer, tpa or broker) sufficient to yield the knowledge requirements above. [Required]
Additional Information: Licenses and Certifications: - Certified Associate in Project Management (CAPM) [Preferred]
- Project Management Professional (PMP) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/23km2677
Pay Range:$80,204.80 - $149,177.60
Background Screening Requirement (Florida Law) Certain positions are subject to
Florida Level 2 background screening, including fingerprinting, as required by state law.
Applicants may review general information about Florida's background screening requirements at the
Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/
