Operations Planning Specialist, PDP Oversight – Monitoring

Job not on LinkedIn

🔥 14 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

💵 $41.7k - $92.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Support daily oversight and monitoring of PDP Enrollment & Premium Billing operations with vendors, internal and external partners • Ensure processes comply with new and existing CMS requirements • Monitor operational metrics, critical volumes, and daily inventory to identify potential issues • Review Service Level Agreements monthly and address issues impacting enrollment and billing operations • Manage weekly monitoring activities, including pulling samples, tracking results and corrective-action evidence, and reporting results to leadership • Perform focused monitoring and audits after operational process changes • Support internal, external, and CMS audit activities by quality reviewing universes, samples, and supporting documentation • Identify and communicate trends and issues and support remediation and process improvements • Support AEP and 1/1 Readiness activities related to enrollment and billing • Review vendor policies and procedures annually for alignment with CMS guidance and company policies

🎯 Requirements

• Bachelor's Degree or equivalent experience • 3-4 years of relevant Medicare (Part D and/or Part C) or other government program experience in eligibility, premium billing or healthcare operations • Proficiency with Microsoft Word, Excel, Outlook, and PowerPoint • Self-motivated and able to work in a fast-paced and heavily matrixed environment • Ability to work independently and as an effective team member • Excellent conceptual and analytical skills • Ability to identify linkages between interfacing systems and processes • Ability to identify issues and manage/execute solutions to resolution • Strong problem-solving skills and detail orientation • Ability to analyze situations and deal with ambiguity • Capacity to learn process and product information quickly and efficiently • Excellent organizational and written/verbal communication skills • Knowledge of advanced Excel, report writing, and analysis activities preferred • Enrollment and eligibility experience and process improvement preferred • Medicare Advantage or Part D experience preferred • Must reside in and be authorized to work in a state where HCSC is approved to employ remote workers • Applicants residing in AK, CA, HI, or NY are not eligible for employment consideration

🏖️ Benefits

• Health and wellness benefits • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives • Annual incentive bonus plan