Operations Health Plan/Small Group Coordinator

Operations Health Plan/Small Group Coordinator

The Operations Health Plan and Small Group Coordinator provides day-to-day operational support and relationship management to medical and dental carriers, maintains and enhances Health Connector interactions with medical and dental carriers, supports small group business operations, and assists in the development of operational improvement projects.

Key Responsibilities include:

  • Act as liaison with health and dental plans, maintaining positive and productive working relationships between the Health Connector and contracted health and dental plans. Represents carriers as stakeholders in all internal activities, meetings, and communications
  • Oversee research and resolution of health and dental plan issues, including gathering required data, coordinating vendor and internal Connector resources, ensuring the timely and accurate analysis of issues, identifying steps for issue resolution, and complete the appropriate communications to carriers and internal partners
  • Review escalated cases and manage communication with carriers to support operations
  • Support the day-to-day operations of the small group vendor including coordinating annual renewal processes, monitoring monthly small business bill and enrollment transactions, engaging internal and external stakeholders regarding small group business needs, reviewing and validating monthly reports, lead rate and systems testing and communicate results with appropriate stakeholders, and support new systems implementation and transitional activities
  • Coordinate external service meetings between Health Connector and health and dental carriers, small group business vendor, and lead internal cross departmental meetings including setting agendas, chairing those meetings and ensuring that all active issues are addressed expeditiously
  • Monitor agreed upon health and dental metrics to ensure operational standards and turnaround times are consistently met
  • Lead health and dental plan reconciliations for the Connector to ensure timely, accurate and complete determinations
  • Support work with IT and Finance teams related to carrier or small group vendor payments

Additional Responsibilities:

  • Work with the Director of Health Plans and Operations to modify and improve health and/or dental plan facing policies and/or procedures
  • Monitor health and dental plan compliance with Health Connector policies and procedures, identify areas requiring improvement and lead efforts to ensure compliance
  • Prepare and deliver presentations and memoranda to internal and external parties
  • Research emerging trends in carrier relations at other SBMs and FFM and communicate findings with Director and others as appropriate
  • Support annual open enrollment readiness projects
  • Other projects and duties as assigned by Director of Health Plans and Operations

Experience and Qualifications:

  • A Bachelor’s Degree is required
  • Health care experience and background including knowledge of both the public and private sectors essential
  • Must possess a strong operations and project management background, with the ability to work on complex projects and meet deliverables within tight timeframes.
  • Must have excellent communication skills, both written and verbal, as well as outstanding interpersonal skills and the ability to work with multiple parties and vendors to implement projects.

Preferred requirements:

  • Master’s Degree in Health care, business, public health or policy strongly preferred
  • Prior experience working at a health or dental plan
  • Bilingual preferred

The ideal candidate must be able to work successfully in a fast-paced environment, have proven ability to successfully multi-task, possess outstanding verbal and written communication skills, strong organizational, project management, analytical, and leadership skills, be able to successfully work independently or on a team, consistently exercise sound judgement, and demonstrate the ability to discern when an issue or situation should be escalated to management.

Salary: Salary range is competitive; salary will be commensurate with experience.

About the Health Connector:

The Commonwealth Health Insurance Connector Authority (Health Connector) is an independent public authority serving as the Affordable Care Act (ACA)-compliant marketplace for the Commonwealth.  The organization is charged with providing subsidized and unsubsidized health insurance to individuals and small employers.  The Health Connector also oversees policy development related to health care reform under both state and federal laws, as well as conducting public education and outreach about health care reform and coverage opportunities.

The Health Connector is an equal opportunity employer that values diversity as a vital characteristic of its work force.  We consider qualified applicants without regard to race, color, religion, gender, sexual identity, gender identity, national origin or disability.

If Interested: Send cover letter and résumé to Connector-jobs@state.ma.us.

Please note: Due to the requirement of 268A, please complete the Applicant Disclosure Form and return with your application.

2016-10-19T19:47:28+00:00 Wednesday, September 28th, 2016|