Job Description

Job Summary:

Position provides senior level analytical support for our health, dental and vision administration outsourcing and medical, pharmacy, behavioral health and flexible spending account programs and vendors. In addition, this position acts as senior project manager for multiple, simultaneous health, pharmacy, dental and vision projects involving highly technically complex systems and processes (historically more than 75 small, medium and large projects per year or at times more than 10 simultaneously). This position provides day-to-day management of internal and external resources (payroll, HRIS, vendor systems and processes) to complete these projects and achieve other program objectives. Plays leading role in ensuring ongoing legal compliance (operationally with the Affordable care Act and other federal regulations.

Responsibilities:

* Responsible for day-to-day health, pharmacy, dental and vision project management and process improvement. Directs the project work of internal and external resources, such as Benefits Administrator, healthcare, pharmacy, dental and vision vendors for a wide variety of technically complex projects. Fully responsible for defining project requirements, setting project responsibilities and establishing accountabilities. Responsible to ensure that deadlines/requirements are achieved.
* Position may be required to coordinate the activities of stakeholders, vendors, benefits service delivery and segment support groups to complete a single project.
* Responsible for the ongoing research and data analysis supporting our health, pharmacy, dental and vision plans and programs. Benchmarks
* Partner with Total Benefits Outsourcing (TBO) vendor and carriers to extract data and develop perspectives. Self-service through data warehouse front end to analyze claims, health assessment data and other inputs. Applies subject matter expertise of prevalent healthcare practices, Benefits Outsourcing, etc. to draw conclusions and insights from analytical results.
* Perform necessary information gathering, analysis, synthesis, and reporting to ensure compliance with local, state and federal benefits regulations.
* Partner with carriers, vendors, business segments to assemble required data elements. Partner with functional subject matter experts (SME) (payroll, legal, etc.) for filing, reporting, and remitting payments. Requires a working knowledge of healthcare industry regulations and practices.
* Resolve healthcare plan operational issues of medium to large (complex) scope (defined by limited or transparent participant impact) issues surrounding data sharing between carriers and/or vendors, and issues resulting from insufficient or inaccurate process mapping.
* Researches program requirements and/or contracts. Identifies best practices. Reviews vendor expectations/capabilities. Seeks direction from leadership and functional SMEs when conflicts arise. Recommends most efficient/effective solutions.

Basic Qualifications:

* 5 -7 years of experience working in health care program operations (internal or outsourced) or consulting position with large, complex organization.
* Demonstrated success collaborating on large teams.
* Knowledge of health, pharmacy, dental, vision federal and state regulations, administrative best practices, advanced project management and vendor management skills.
* Extremely well organized, excellent interpersonal and diplomacy skills.
* Excellent analytic skills.
* Expert in MS Access and Excel; Proficient in extractions from ERPs and data warehouses.

Preferred Qualifications:

* Knowledge of health, pharmacy, dental and vision provider networks, health, pharmacy, dental and vision plan administration best practices, contract negotiation and administration, etc.
* Familiarity in writing data warehouse queries; SAP (R/3 and BW); Cognos database management GUIs.
* Proficiency in project management software.

Required Education

Bachelors degree or equivalent work experience

Preferred Education

* Masters degree
* Working toward Group Benefits Associate (GBA) or Certified Employee Benefits Specialist (CEBS) designation or equivalent is a plus.