Location: St Louis, MO
You could be the one who changes everything for our 25 million members. Our Client is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
This role will provide strategic direction for all enrollment functions by providing technical and leadership support. Oversee enrollment functions to ensure that all efforts are parallel with the mission and objectives of the plan.
- Oversee the Eligibility and Enrollment department staff
- Establish working relationships with external sources with Health & Human Services Commission (HHSC), state enrollment broker and other local state offices
- Collaborate with internal operations teams to identify efficient solutions to meet business needs related to enrollment and facilitate continued process improvement
- Establish and maintain liaison relationships with corporate IT to support and facilitate the common goals and objectives related to enrollment and eligibility services
- Design and test new codes sets and processes for new product implementation to include business rule integration and state contract compliance
- Manage and establish file interchanges with external vendors and affiliates including the mailhouse
- Direct resolution to state complaint trends related to enrollment and eligibility
- Represent the health plan in state MIS meetings
- Develop and implement a reconciliation process of enrollment and financial records
- Direct the eligibility load process while coordinating with corporate IS department to resolve issues that arise during the process
- Coordinate monthly reconciliation process of remittance files by resolving discrepancies in the report
- Additional Responsibilities:
- Lead Enrollment effort regarding Auto Provider Assignment across all Lines of Business (where applicable)
- Coordinate with Health Plans on strategy and timing of provider assignment.
- Coordinate with Enrollment Platform (UMV) Product Owner team to execute Provider Assignment strategy.
- Coordinate with Enrollment, Membership and Billing User Acceptance Team to assure provider assignment changes are tested appropriately.
- Coordinate with Provider Data team and Health Plans on termination of providers and member moves.
- Coordinate with Enrollment, Membership and Billing Training to ensure consistent approach across all lines of business.
- Coordinate with Information Technology Auto Provider Assignment Team
- Coordinate with the Enterprise Data Team
- Coordinate with the Product Owners for Enrollment and Provider platform.
- Other duties and responsibilities as assigned by leadership
- Ensure value capture of APA and corresponding tracking validation with Business Owners | Health Plans
- Coordinate with the Engagement, Data, Productionation & Algorithm leads ensuring business alignment with model design/approach
- Tracking and aligning on all IT/Business costs ensuring project aligns with budgeted funding
- Engage in Program Increment (PI) to ensure IT resources allocated to Initiative remain dedicated resources
- Our Comprehensive Benefits Package:
- Flexible work solutions including remote options (local to St. Louis), hybrid work schedules and dress flexibility
- Competitive pay
- Paid Time Off including paid holidays
- Health insurance coverage for you and dependents
- 401(k) and stock purchase plans
- Tuition reimbursement and best-in-class training and development
- Bachelor’s’ degree in related field or equivalent experience.
- 7+ years of managed care or government programs preferred.
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.