The Insurance / Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare.
Develops and implements general insurance and health policies in accordance with state and federal laws. Responds to provider and member concerns resolve problems / issues.
Provides directions for utilization review. Ability to collaborate with, state officials and with organized healthcare groups and associations on various Medicaid member issues related to benefits and data maintenance.
- Effectively manage a team of 10 Member Eligibility Specialists
- Preform and manage administrative duties such as employee performance, training, evaluations, corrective actions and time management.
- Provide ongoing internal customer support for process questions and problems.
- Oversee operational support for an internal update platform to facilitate member file maintenance.
- Interact and foster a good working relationship with the client as well as Department of Family and Children Services (DFCS)
- Manage Medicaid member-related business support responsibilities, which include production monitoring, file maintenance, ad hoc reporting, and consultation with internal and external users.
- Develop analytical skills and increases applications knowledge within the team and lead efforts to develop department core competencies, execute cross training, and implement succession plan.
- Review data and make independent decisions.
- Applies extensive knowledge of business unit processes to support requirements of business unit.
- Ensures customer satisfaction by handling unique and difficult situation / projects under minimal direction in a timely and quality manner.
- Able to resolve / recommend action on most issues.
- Handle escalated issues from customers with minimal assistance.
- Ability to design and implement training programs for internal and external customers.
- Serve as liaison between client and account staff with regard to training and education.
Education and Skills
Education and Experience Required :
- Minimum bachelor’s degree and 2 years of supervisory experience managing at least 4 people (additional supervisory experience may substitute for the degree on a year-for-year basis).
- Typically, 5-8 years of working experience.
Knowledge and Skills :
- HIPAA security policies and procedures
- Strong level of understanding and application of healthcare related technologies.
- In-depth knowledge and experience with project management, research and problem resolution techniques.
- Ability to plan and meet deadlines for complex projects / issues with knowledge to others.
- Subject matter expert regarding policies and procedures.
- Ability to research and resolve customer and leader inquiries by identifying trends and utilizing available resources.
- Self-motivated with strong time management and organizational skills.
- Provide assistance to team and peers.
- Working knowledge of Avaya Contact Center Manager System a plus but not required
- Office Environment
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