This position is responsible for the management oversight of Medicaid claims and customer service in collaboration with HCSC Enterprise Medicaid and in accordance with contractual and regulatory requirements. Serve as point of contact with HCSC Enterprise Medicaid Operations and coordinate with key functional areas across the organization, local vendors, and 3rd party business partners with the development and implementation of Medicaid Operations. Serve as business lead responsible for implementing HFS and CMS regulatory and contract changes (i.e., state fee schedule benefit changes and annual regulatory changes) including process and system changes. Position will also oversee Medicaid Member Services and responsible for managing relationships with local Medicaid vendors.
Bachelor Degree and 4 yrs operations experience OR 8 years experience working in health insurance operations
3 to 4 years experience leading and managing teams
Experience in project management
Experience managing operations for Medicaid, Dual Demonstration or other related Medicaid Medicare Advantage programs
Experience in business planning, time management, project management and organization skills with ability to multi-task and manage multiple, concurrent projects and priorities
Experience planning and driving business initiatives through implementation
Possess leadership, communication skills (oral and written) and ability to exercise strong interpersonal skills in varying, cross-functional situations
PC proficiency to include Word, Excel, PowerPoint and Lotus Notes
PREFERRED JOB REQUIREMENTS:
Background in administration of contracts for State and Federal Government.
Experience managing vendor relationships
Facet knowledge preferred
Blue Chip knowledge preferred
*Knowledge of call center management and performance monitoring
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Expertise Claims & Customer Service Job Type Full-Time Regular Location OK – Oklahoma City