Company Statement
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Claims Accumulator Oversight Manager (Remote)
Summary of Position:
- Provide oversight of Business Process As A Serivcie (BPAAS) business partners’ performance of the processing of the accumulations SLAs in order to minimize errors, reduce/eliminate risk of non-compliance with SLAs, and minimize customer dissatisfaction.
- Initiate PPMs and work with IT to resolve complex encounter and accumulator file exchange issues between IT and Vendors.
- Partner with Relationship managers, IT and delegated vendors on all accumulator related process updates/changes.
- Ensure consistent and accurate exchange of accumulator data by auditing both outgoing and incoming files.
- Manage the setting up of delegates, data analytics, and related actions designed to minimize/mitigate risks of improper handling, transferring, or reviewing of records and data.
Principal Accountabilities:
- Ensure that the performance of external vendors charged with managing accumulator files meets or exceeds contractual specifications to minimize risk of financial exposure to the company and customer dissatisfaction.
- Drive knowledge management performance of vendors for accumulator file exchanges to meet SLA requirements and align with EmblemHealth customer experience objectives.
- Collaborate with internal/external parties as necessary to identify and remove impediments to customer satisfaction: serve as Claim liaison between Enterprise Relationship Manager, Delegated Vendor and BPAAS business partner on claim and accumulator reconciliation.
- Ensure the quality of file feeds result in expected outcomes to limit customer abrasion.
- Drive vendor accumulator exchange set up including: documenting requirements, reviewing testing scenarios and results; identifying errors; and recommending changes to file.
- Communicate and collaborate with CTS BPAAS on all activities related to accumulator reconciliation; work with RM and vendor when changes are needed to incoming files that support accurate accounting of accumulators.
- Manage reporting process: conduct oversight of over accumulation report and accumulator error reports to ensure CTS is working the reports timely and accurately.
- Identify single or recurrent issues; collaborate as needed to discover root causes and trends; provide and implement recommendations to reduce/eliminate risks due to non-compliance, errors, etc.
- Monitor trends and submit required PPMs to address production break fixes or enhancements.
- Implement and manage audit of data exchanges to ensure data integrity; perform audits for incoming file loads to Facets and outbound files to vendors and report results to leadership.
- Perform other tasks as required or directed.
Qualifications:
- Bachelor’s Degree, preferably in a business-related discipline required; additional years of experience may be considered in lieu of educational requirements
- 4 – 6 years of related professional work experience required
- 1 – 3 years’ experience working in BPASS model preferred
- Strong knowledge of claim processing, procedures and systems, State, Federal and Medicare Regulations required
- Extensive knowledge of professional and facility claims processing systems required
- Excellent organizational and time management skills required
- Strong analytical and deductive evaluation skills to anticipate and resolve potential claim systems discrepancies required
- Ability to identify issues, and to develop and propose effective solutions required
- Proficiency with MS Office applications (Word, Excel, Access, etc.) required
- Effective communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences required
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.