Plan Benefits Manager

Western Health AdvantageSacramento, CA, US

11 days ago

Job type

Full-time

Quick Apply

Job description

Summary Description :

The Plan Benefits Manager is responsible for leading and overseeing new healthcare plan deployments and plan changes, as dictated by Affordable Care Act (ACA) and market needs.
The Plan Benefits Manager provides project management, supports vendor relationships, provides relevant and timely data, and collaborates with internal and external clients to explore feasibility of prospective changes.
The Plan Benefits Manager is the primary source for benefit plan information and leads the creation of products and project modifications to meet regulatory compliance standards.

Representative Duties :

Promote and adhere to WHA’s Privacy and Information Security Programs.

Ensure and verify that all department Workforce Members attend and complete mandatory training.

Inform Workforce Members that WHA will take disciplinary action up to and including termination of employment for violation of these privacy and security policies, procedures, and regulatory requirements.

Also, strict adherence to the related laws, rules, regulations, policies, and procedures is considered an integral part of their job performance and monitor compliance.

Support the functional area Chief and / or Director with the development and implementation of the organizational plans, strategies and annual budget.

Review and analyze department actual performance against the targeted performance objectives leveraging company data applicable to the department, available KPI (Key-Performance Reports) and other available performance measurement resources.

Work collaboratively and cooperatively with functional area Chief and / or Director to develop and implement supplemental plans and / or strategies to mitigate departmental performance gaps to stated business objectives and / or targeted KPI results.

Support the functional area Chief and / or Director with the process of aligning and documenting the department’s business priorities, goals and objectives on a quarterly and / or monthly basis so as to achieve business targets as set forth in the annual business plan.

Interface and collaborate with departmental team members, as well as other functional area leaders, on special projects and / or towards the accomplishment of company-wide business goals, objectives and project deliverables.

Represent and effectively present departmental performance information, project updates and other miscellaneous information to a variety of internal or external organizations, business clients, consumers and / or the general public.

Support the functional area Chief and / or Director with the development and maintenance of key-stakeholder relationships relevant to the department and / or the company.

Collaborate with functional area Chief and / or Director on the departmental staffing plans and processes to support the effective execution of the departments and / or company’s business plans, strategies and initiatives.

Work collaboratively with Human Resources and the functional area team members to select, train, supervise, and effectively performance manage the department’s staff.

Maintain consistently high-performance standards for all direct reports and other team members by regularly communicating business updates, coaching, counseling, disciplining and completing timely performance evaluations in accordance with the company’s Human Resources guidelines and standards.

Establish and execute personal and professional development initiatives for direct reports and team members and self for the purpose of keeping current and effective in the performance of their various job duties and roles.

Collaborate with leadership and the CORE office in the design, testing, planning, and implementation of complex projects that affect internal departments and outside memberships.

Troubleshoot existing programs and recommend / implement program changes when necessary.

Develop and implement a broad and coordinated set of plans and programs to meet the goals and priorities of the company and its internal departments.

Serve as a liaison between internal and external clients for new product implementations as they relate to plan benefits, to streamline processes.

Provide load files and other benefits details necessary to support the following processes and / or vendors (list is subject to change) :

the welcome kit / ID card process for Members; annual benefit updates for our Dental vendor, our Chiropractic / Acupuncture vendor, the Pharmacy Benefit Manager (PBM), Facets, Milliman (for creditable coverage purposes), Master Health Plan (MHP); and other exports as needed, to include new processes and vendors not currently in place.

Work with the Facets team to ensure new products and all associated components are loaded into the system appropriately and are ready to use when needed.

This includes having a basic understanding of Facets and how it interfaces with all other systems.

Maintain and update (or oversee the update / maintenance of) the Central Benefits Driver (CBD) or other benefit management system to include year-over-year updates, creating product IDs for new benefit plans, and updates due to regulatory requirements or company mandates.

Manage the vendor relationship necessary for the entry and maintenance of plan benefits information and the production of the following key plan documentation :

Copayment Summaries, the Summary of Benefits and Coverage (SBC) documents, Combined Evidence of Coverage and Disclosure Form booklets.

In collaboration with the Sales, Legal and Marketing departments, develop this documentation for new plans, review and prepare recommended edits of existing plans, respond to client concerns, and identify areas for improvement.

Maintain and build relationships with assigned vendors to include coordination with other internal departments for training sessions and working with vendors on contract renewal terms.

Audit finalized products and processes, including online documentation for members use.

As the primary source for plan benefit information, serve as the point of escalation, within the Benefits department, for benefits-related correspondence with both internal customers and vendor partners.

Oversee benefits configuration in vendor systems and support the work of partners in Claims and Eligibility as they map to partners’ systems.

Host the Benefit Task Force (BTF) meetings at a regular cadence, to include prepping agenda topics, maintaining meeting minutes, and reviewing the effectiveness of BTF on an annual basis, making changes to the format as needed.

Maintain department Policies and Procedures, updating them annually or as needed.

Perform other duties and special projects as assigned.

Qualifications :

Bachelor’s degree in business, Management, or a related discipline.

4 years’ experience as a Senior Benefits Analyst, Business Analyst, or similar role.

2 years’ experience managing direct reports, approving schedules, etc.

Strong working knowledge of how medical and pharmaceutical plans work.

Working knowledge of Facets, specifically as it applies to products and benefits, a plus

Proficient computer skills, including e-mail, routine database activity, word processing, spreadsheet, graphics, etc.

Must be able to speak, read, write, and understand the primary language(s) used in the workplace Salary : $85,000.00 - $100,000.00 Annually Western Health Advantage is committed to providing equal employment opportunities to employees and applicants for employment on the basis of merit and without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, medical condition, genetic information, marital status, ancestry, military or veteran status, or any other basis made unlawful by federal or state law.

Western Health Advantage values and supports the unique talents and strengths that each employee brings to our organization.

Collaborating with the best and the brightest means a dynamic, fulfilling work experience for you — and excellent customer service for our members.

WARNING :

Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies.

Please be advised that Western Health Advantage will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company.

If you feel that you have been the victim of a scam such as this, please report the incident to the to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option.’ Powered by JazzHR

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Plan Manager • Sacramento, CA, US

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