Campus Pride Jobs

POSITION SUMMARY

Lead the implementations, administration, and operations of new and existing product owned delegated entities and vendors ensuring compliance with regulations, including status communication to management and other operational partners.

PRIMARY ACCOUNTABILITIES

1. Develop oversight plans for product owned delegated vendors.
2. Ensure KPIs and SLAs of delegated vendors meet contractual requirements and operational needs.
3. Ensure all regulatory reporting requirements are met by vendors and delivered to operations within regulatory timeframes.
4. Collect data and compile annual Supplemental Benefit Part C reporting.
5. Collect and analyze complaints and utilization of HF supplemental benefits to optimize operational efficiencies and member satisfaction.
6. Compile and provide annual benefit grids to vendors and appropriate eligibility to internal data management team to ensure accurate benefits are administered for appropriate enrollees.
7. Oversee and manage vendor related escalations from HF operational departments.
8. Be an internal resource for the implementation and oversite of product owned delegated vendors including providing objective and professional evaluations of the vendor portfolio and operational readiness for product delivery. Must mediate between key functional areas to ensure that product and benefit requirements are fully understood.
9. Ensuring all inputs and exports from vendors are completed effectively and timely.
   10. Lead monthly collaborative meetings with Product owned vendors to ensure a productive and positive working relationship.

MINIMUM QUALIFICATIONS

• Education: Bachelor’s degree
• Licensure: None
• Certification: None
• Work Experience: Three (3) years of experience with health plan or healthcare business office.
• Work Experience in lieu of Education: Five (5) Years of health plan or healthcare business office experience.
• Knowledge/Skills/Abilities o Proficient in Microsoft Office Products especially Excel & PowerPoint. o Ability to build relationships, communicate effectively and work collaboratively at all levels in organization. o Highly organized, motivated, responsible self-starter, with excellent time management, analytical and research & critical thinking skills. o Subject matter expertise in the product life cycle for benefits development. o Knowledge of Medicare, Commercial and Individual coverage/guidelines in the HMO and PPO arena. o Ability to read, analyze and interpret complex professional/legal/regulatory documents, contracts, policies, procedures, government regulations and legislative documents.

PREFERRED QUALIFICATIONS

• Education: Bachelor’s degree in health care, business administration or a related field from an accredited college/university.
• Licensure: No additional required
• Certification: None
• Work Experience: Experience in Product Development health plan setting.
• Knowledge/Skills/Abilities: o Advanced knowledge of Heath First Health Plan’s product offerings. o Experience working with health insurance regulatory issues.

PHYSICAL REQUIREMENTS

• Majority of time involves sitting or standing; occasional walking, bending, stooping.
• Long periods of computer time or at workstation.
• Light work that may include lifting or moving objects up to twenty pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined; on site or remote.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Job: *Operations

Organization: *HF Administrative Plan Inc

Title: Delegated Operations Lead - Product Development

Location: Florida - Brevard County-Rockledge

Requisition ID: 074548