Summary:

Manage the execution of internal business processes, in one or multiple regions and across multiple cross functional teams, to meet market requirements for quality, accuracy and timeliness in an efficient and effective manner. Serve as the responsible party and central point of contact to collaborate with all internal functional partners to research and resolve internal inquiries or issues and member/customer inquiries or issues.

Major Responsibilities:

• Manage the execution and coordination of all internal regional business processes related to the Request for Proposal (RFP).

• Lead and drive the request for status quo and alternate renewals for National Account customers.

• Execute, as necessary, any regional processes required for benefit exceptions if requested.

• Partner and collaborate with regional and National Underwriting (UW) and follow regional processes in support of getting rates for status quo and alternate benefit requests.

• Partner with National Proposal Development (NPD) and Underwriting (UW) to ensure benefits and rates are accurate.

• Escalate any concerns for meeting critical deadlines to Regional Account Management (RAM) and National Account Team in a timely manner.

• Audit final RFP submission documents for accuracy and completeness.

Escalate as necessary and/or secure RAM approval.

• Confirm that regional global benefit changes are included in RFP submission.

• Manage execution of all internal regional business processes related to the Summary of Benefits and Coverage (SBC) for Fully Insured business.

• Distribute complete and accurate final SBC to National Account Team.

• Act as central point of contact for regional SBC follow-up questions.

• Validate benefits and cost shares on draft SBC document received from regional SBC teams.

• Lead and manage the execution of all internal regional business processes related to Confirmation and Installation Seasons.

• Review and validate the accuracy of the final confirmed provisions and rates template.

• Execute regionally required processes to begin installation of sold renewal.

• Responsible for managing, updating and collaborating with NAAMs to ensure an accurate Standardized Account Structure template is available in each region.

• Partner with Case Installation when they are assigned (including Expert Team Meeting call).

• QA and submit documents that inform what goes into regional membership systems ensuring cross-functional downstream partners have accurate documentation to be able to generate critical documents.

• Complete comprehensive QA post-installation to ensure all downstream (internal and external) outcomes and experiences are positive, mitigate re-work, reduce potential investments, and ensure excellent member experience at the point of service.

• Provide excellent service; pursue exceptional outcomes; deliver timely and accurate resolution of requests; and act as a collaborative influencer utilizing effective communication.

• Serve as responsible party and central point of contact to collaborate with internal functional partners to research and resolve member/customer inquiries or issues.

• Consult with Regional AM to resolve internal inquiries or issues when internal partners are compromising the quality of work.

• Serve as the primary point person for National Account Team and internal partners if RAM is in the field.

• Partner with Underwriting to assist in resolving rate issues; complete root cause analysis and communicate/share learning.

Required Qualifications:

• Bachelor's degree in business administration or health care administration or related degree OR four (4) years of experience in a directly related field.

• High School Diploma or General Education Development (GED) required.

• Minimum of two (2) years account service experience and/or case installation/implementation within the health insurance industry.

• Prior project/program management experience.

• Technical experience in on or more of the following areas: provider billing, claims administration, provider relations, provider contracting, revenue cycle finance, and data analytics.

• Knowledge of health insurance market.

• Knowledge of health plan administration and operational needs for complex health insurance products, including self-funding and private exchange.

• Strong interpersonal skills.

• Proficient in all Microsoft Word programs.

• Technically savvy - comfortable working with a diverse number of systems and tools.

• Strong time management and organizational skills.

• Able to manage multiple high demanding priorities.

• Comfortable working within a team environment that requires consistent process management.

Preferred Qualifications:

• Four (4) years account service experience and/or case installation/implementation within the health insurance industry.

• One (1) year group insurance experience.

• Working knowledge of underwriting processes, healthcare products and contracts.

• Knowledge of current / future trends and changes in healthcare/health insurance laws/regulations.