Contract Specialist

GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees, and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees.

GEHA has one mission : To empower federal workers to be healthy and well.

Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization.

Position Overview : Provides technical oversight to Health and Business staff on correspondence and contracts, responding to questions, complex service issues, demographic data, and workflow issues. Assists department with special projects, implementation, and execution of new programs and processes. Analyzes department production reports, turnaround time, and various department data.

Skills & Responsibilities :

• Serve as the main point of contact for healthcare providers, addressing inquiries and concerns promptly.
• Resolve provider-related issues and disputes efficiently.
• Provide support to providers on policies, procedures, and issue resolution practices.
• Complete telephone records supplying all information necessary to resolve providers' concerns.
• Actively engage in communication and response with internal and external customers.
• Maintain production and quality to ensure that department standards and goals are being met.
• Research network service issues.
• Coordinate with Contract Admin and supervisor to determine appropriate actions needed for resolution or to resolve issues.
• Analyze and investigate all issue categories including quality assurance issues and coordinate with appropriate parties to resolve issues.
• Work with Contract Admin or Supervisor to implement workflows related to implementation activities.
• Create and modify network management desk level procedures as needed.
• Identify issue trends to assist with workflow updates or changes, and help with job aides and desk-level procedures.
• Assist with projects resulting from network pricing adjustments, determining workflows, resources needed, and coordinating with internal departments to minimize impact.
• Work with Quality Assurance Specialist to review audit results and handle appeals when issues are identified.
• Address daily reports from internal areas and plan inquiries.
• Perform other duties as assigned.

Requirements : Education & Experience

Work-from-Home Requirements :

Benefits & Compensation :

Note : Salary is a guideline; factors include scope, experience, education, skills, and market considerations.

GEHA is an Equal Opportunity Employer, committed to diversity and inclusion, and does not discriminate based on protected characteristics.

Headquartered in Lee's Summit, Missouri, near Kansas City, offering hybrid and remote work options.

J-18808-Ljbffr