Manager Health Plan Benefit Administration
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Accountable for the benefit book member contracts and plan attachments from concept through member distribution for individual, Medicare Supplement, pooled group, and custom segments, ensuring language complies with legal and business requirements while being as member-friendly as possible.
REQUIRED QUALIFICATIONSRequired Work Experience
- 8 years of experience in healthcare, business, or a related field
- 5 years of experience with health insurance or benefits administration
- 5 years of experience in operational management
- 3 years of experience in business writing
- High-School Diploma or GED in general field of study
PREFERRED QUALIFICATIONSPreferred Work Experience
- 10 years of experience in health insurance or similar field
- 7 years of experience with medical benefits
- 7 years of experience in operational management
- 5 years of experience in business writing
- 3 years of experience with DIFI filings or related legal/compliance experience
- 3 years of project management
- Bachelor’s Degree in Business or related field
ESSENTIAL job functions AND RESPONSIBILITIES
- Oversee the production of member contracts through benefit books, riders, plan attachments, and Summary Plan Descriptions for individual, pooled group, and custom segments.
- Create and maintain workflow processes, documentation, and reporting to support the entire benefit book life cycle.
- Ensure effective benefit book administration processes through engagement of business segments while maintaining focus on the customer and legal impacts.
- Work with various teams and departments to improve communication, provide deliverables, and develop successful workflow processes.
- Analyze processes and performance results to drive improvement initiatives, introducing technology where appropriate.
- Assist with benefit book creation as needed during busiest times
- Plan and organize a detailed course of action that ensures accurate and timely completion of benefit books.
- Monitor the status of benefit books from initial drafting through member distribution.
- Monitor and track to Arizona Department of Insurance and Financial Institutions (DIFI) requirements and timelines.
- Monitor complex benefit and operational research and changes, resulting impacts across all product segments and timelines, and provide recommendations for resolution.
- Determine if new benefit books are required or if riders are sufficient to communicate changes.
- Determine the timing of benefit book changes based on operational risk.
- Determine how general or specific language changes should be, or if they are necessary at all.
- Approve or draft language changes to incorporate into benefit books.
- Monitor required and completed changes made to benefit books.
- Comprehend detailed benefit, operational, and legal requirements across all segments to provide guidance and make decisions while minimizing legal risk.
- Perform on-going risk analysis and escalate to management any high profile concerns or issues.
- Leverage expert business and analytical knowledge to participate or lead cross functional teams to understand complex business objectives and influence solution strategies.
- Invest in relationships to successfully influence and build shared goals to achieve optimal results.
- Collaborate with various departments to ensure benefit book language accurately describes current processes and any upcoming changes.
- Research and respond to questions or requests received from internal customers.
- Attend meetings relating to benefit book administration and other topics as necessary.
- Participate in budget and forecast activities to contribute to departmental targets.
- Build and manage a strong Benefit Book Administration team through effective talent management and positive employee engagement.
- Coach and mentor staff to make maximum use of experience, knowledge, and skills.
- Oversee the activities for all staff levels within the Benefit Book Administration team.
- Monitor performance and provide timely feedback to team members.
- Build critical connections and bridges between direct reports and other business segments.
- Provide guidance and direction for escalated issues and engage management when needed.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.
REQUIRED COMPETENCIESRequired Job Skills
- Strong analytical and problem solving skills
- Strong written and verbal communication skills
- Intermediate business writing skills
- Intermediate skill in spreadsheets and word processing
- Intermediate PC proficiency
- Intermediate skill in use of office equipment
Required Professional Competencies
- Sound judgement and ability to make independent decisions
- Ability to identify issues and drive them to resolution
- Advanced analytical skills regarding issues that are complex and not readily defined
- Ability to establish and maintain working relationships in a collaborative team environment
- Effective management skills in an operationally changing environment
- Ability to draft language that meets legal and business requirements while being as member-friendly as possible
- Ability to manage time effectively
- Maintain confidentiality and privacy.
- Sound business ethics and principled leadership
- High standard of performance while pursuing aggressive goals
- Ability to take appropriate risks using available data
- Ability to use available information to identify priorities and focus the team's activities
PREFERRED COMPETENCIESPreferred Job Skills
- Detailed knowledge of benefit designs especially as it relates to Health Care Reform (ACA).
- Knowledge of a wide range of matters pertaining to the organization's operations.
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.