Supervise and coordinate the delivery of Health Risk Management services provided to Medical Stop Loss captive program member owners. This is accomplished by establishing, managing and maintaining relationships between captive members and service providers. Leads coordination of annual captive program workshop agendas and planning, preparation and planning for monthly educational webinars, coordination with third party vendors and service providers, creating and updating reports and presentations including presenting in front of large groups. The role also leverages healthcare claim data for analysis, reporting and identifying cost containment opportunities.
ESSENTIAL EDUCATION AND EXPERIENCE:
Bachelor’s Degree in Business Administration, Healthcare Management, or related discipline and at least six (6) years of experience in the health and group benefits insurance, client service or consulting industry is preferred.
SKILLS/COMPETENCIES REQUIREMENTS:
- Strong knowledge and understanding of TPA services and medical networks
- Knowledge and experience working with PBM Services
- Knowledge and experience with medical and pharmacy benefit Plan Design
- Ability to work with member companies
- Knowledge of health care, managed care, Medicare or Medicaid.
- Ability to formulate opinions regarding claim and utilization data and cost trends
- Knowledge of Self-Funding and specifically Self-Funding with Stop Los
- Excellent written and verbal communication skills
- Comfortable presenting to large groups
- Organizational, planning, and prioritization skills
- Strong analytical, problem solving, and judgment skills
- Works well independently and in a team environment
- Strong customer orientation
- Interpersonal skills
- Commitment to company values
- Proficient in Microsoft Office
- Willingness and ability to travel frequently
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Stay abreast of healthcare market trends and intelligence, including but not limited to wellness and cost containment practices and trends, medical and pharmacy coverage options and trends in the marketplace, awareness of Third-Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) in market as well as point solution vendors
- Consultation: We consult with captive members regarding best health management practices, policies and procedures.
- Manage the Health Risk Management assessment process, communicating with members
- Captive portal management
- Attend and participate in captive program board meetings (generally 1 meeting per year per program)
- Manage and coordinate Health Risk Management Related Workshops, Webinars, and other services:
- Selecting meeting locations and drafting meeting agendas
- Soliciting suggestions from program members
- Identify presenters of various service options (PBMs, trends, plan design options)
- Facilitate workshop topic discussions
- Evaluate the program with the use of member surveys and build future workshops accordingly
- Conduct and assist with presentations
- Technical support and research
- Stay abreast of applicable laws
PRIORITIES:
Thorough Analysis, Facilitation of High-Quality Workshops, Webinars, and Other Training, Customer Service/Relationships, Health Risk Management and Benefits, Self-funded plans
TRAVEL:
Required, both domestically and internationally for this position. This includes compliance with all the requirements of the localities and destinations, as well as transportation carrier requirements.
