Medical Vendor Oversight Specialist, REMOTE with travel required

3 weeks ago

Lansing, United States Accident Fund Holdings, Inc. Full time

Job DescriptionREMOTE opportunity with required travel to the Lansing, MI office, as needed. The Medical Vendor Oversight Specialist will provide day to day monitoring of relationships and partnerships to ensure the effectiveness of the programs or services offered by the medical vendors. This position will have a wide variety of specialized functions in support of MMP&S with primary focus on cost containment vendors. This position will conduct due diligence on vendors, including sitting on the selection committee along with brand representatives. Responsible for generating, maintaining, analyzing and reporting the results of audits and review of vendor, monitoring performance and compliance with the contract. Responsible for performing administrative tasks which may be highly confidential and sensitive in nature utilizing considerable independent judgment.RESPONSIBILITIES/TASKS: (Brief bullet points detailing the tasks for this position) Takes the lead on vendor issues following submitted complaints and provide resolutions to meet internal performance standards. Direct, communicate, assign and manage work referred to vendors. Assist in implementing of new vendor services, including communication and workflow/ processes. Develop and manage vendor relationships including scheduling of meetings, greeting and assisting vendors. Works closely with manager and brands on request for proposals and request for information. (this would be done if manger was not available or employee was given proxy from manager) Analyze documents and activities found in the queues such as OnBase, Medata and/or Claim Center etc. Inform appropriate staff of issues as necessary. Analyzes trends and reviews reports as requested or scheduled (i.e. metrics, scorecards, compliance, cost center etc.). Prepares materials for presentation to all customers while maintaining confidentiality. Trains MMX team and internal customers on the use of reports located on the enterprise claims portal. Evaluate and monitor medical cost containment vendors based on service needs of the brands and ensure cost containment efforts are being met. Responsible for ensuring vendor compliance to corporate standards (i.e. timely submission, purchasing, timekeeping, licensing). Conducts annual vendor audits as scheduled or on an as needed basis. Make recommendations for metrics used to measure vendor performance. Respond to calls, email communication and provides information to vendors, insured, providers or routes calls to the appropriate staff. Establishes and maintain effective working relationships with all internal and external customers. Develop a strong relationship and partnership with the claims department. Assist in the development of team goals. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.EMPLOYMENT QUALIFICATIONS:EDUCATION:Bachelor's degree in insurance, business or a related field required. Relevant combination of education and experience may be considered in lieu of degree. College level medical courses required. Continuous learning, as defined by AFHI's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. CAWC highly preferred.EXPERIENCE:A minimum of one year of experience in an insurance organization or completion of trainee program with demonstrated skills in the areas of medical cost containment vendors, oversight of vendors, auditing and contract review. Workers compensation experience preferred.SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: (Brief bullet points detailing the skills necessary for this position) Ability and proficiency in the use of computers and company standard software specific to position. Knowledge of workers' compensation laws and regulations, including jurisdictional laws. Effective customer service skills. Ability to negotiate, build consensus and resolve conflict. Ability to manage multiple priorities and meet established deadlines. Attention to detail and analytical skills. Ability to work independently as well as within a team. Ability to work effectively in a multi functional business unit. Excellent oral and written communication skills. Ability to comprehend consequences of various situations and to make appropriate individuals aware of these to facilitate decision making. Excellent organizational skills and ability to prioritize work. Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format. Ability to effectively exchange information clearly and concisely, present ideas, report facts and respond to questions, as appropriate Ability to provide customer service by responding appropriately to inquiries or concerns from agents, policyholders, regulatory agencies, management, and employees. Effective presentation skills in a variety of settings. WORKING CONDITIONS:Work is performed in an office/remote setting with no unusual hazards. Minimal travel required with occasional overnight stays. Work is required at various times of the day and sometimes weekend work may be required.The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. Pay Range "Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $46,100 and $77,200." We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.#LI-MG1About the TeamAccident Fund Insurance Company of America

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