Summary
 

Responsible for the successful and operational implementation of surrogate new sales/renewals and local accounts for the surrogate business that have sites in other states on ITS, including but not limited to, communicating with other Plans, Marketing, external groups, Testing, Claims Processing & Financial Disbursements. Manages the support of other BC Plans in quoting and implementing National Account business with locations in SC, including enrollment meetings.

Description
 

Manages the coordination with other Plan(s) involved with respective National Accounts Administration through conference calls, on-site account/plan visits/work sessions.

Manages the accurate communication of specific benefits for National Accounts to Benefit Files/Test Team/EDP Claims/USA/BCA/etc.

Coordinates with all operational departments on the administration of the particular National Account.

Assists Marketing and Provider Contracting as necessary with the education and service of National Accounts to be processed through ITS.

Responsible for ensuring that the appropriate operational tasks are completed for implementation of new surrogate and par accounts.

Responsible for the coordination with BCA and all internal departments to establish NMIS goals and processes to achieve and to provide appropriate methods for tracking and improvement.

Develops and guides/directs staff and ensures excellent customer service is given to employees, business units, outside agencies, vendors, etc. Responsible for staff selection and development, disciplinary actions, performance reviews, projects, and resource planning. Prepares, monitors, and analyzes cost center expenditures.

Required Education: Bachelor's in a job related field
Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience

Required Work Experience: 5 years health insurance benefits/TPA operations experience

Required Skills and Abilities: In-depth knowledge of health insurance benefits/TPA operations and managed care principles. Knowledge of and ability to work with annual budget and costs associated to this LOB. Knowledge of BCA National Accounts Guidelines, Matrix Benefits & Uniform Medical Policy. Knowledge of National Accounts Equalization Formula for setting administrative fees. Knowledge of National Accounts Enrollment Group summary and servicing agreement. Knowledge of other departments within the corporation and how these departments interact with each other. In-depth knowledge of all internal systems, including ITS software and OOA policy. Excellent judgment, organizational, customer service skills. Excellent verbal and written communication skills. Ability to persuade, negotiate, or influence others. Ability to handle confidential or sensitive information with discretion.

Required Software and Other Tools: Microsoft.

Preferred Work Experience:

Experience with personal savings accounts (HRA, FSA, HSA)
3 years-claims, membership or marketing operations. Previous supervisory experience or equivalent military experience in grade E4 or above..

Preferred Software and Other Tools: Proficiency with DB2, Easytrieve, or similar data retrieval tools.

Work Environment: Typical office environment. Work may involve out of town travel. Work may involve transportation of materials.

 

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Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.