Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Claims Accumulator Oversight Manager (Remote)
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- Manager & Professional
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- ConnectiCare
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- Nov 28, 2022 Post Date
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
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
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.
Sponsorship Statement
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, Emblemhealth may provide work visa sponsorship for certain positions.