Senior Health Plan Benefits Associate

Collective Health•Lehi, UT

4d•$36 - $45•Hybrid

About The Position

At Collective Health, we’re transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design. As part of the Group Administration team within Health Plan Operations, the Plan Operations team owns specialized processes that require close collaboration with finance, legal, product, and other internal teams. The Plan Operations -- Plan Structure, Launch & Design team (PSL&D) will be responsible for owning and further developing key processes that support and enable the Member Claims team and successful client implementations. PSL&D owns, builds, and maintains Collective Health’s core business logic and system while implementing our clients’ healthcare plans onto the Collective Health platform. What you'll do: Review proposals for improvement and provide support for projects focused on improving Standard Operating Procedures and compliance with internal controls and eternal regulations. Maintain and support overall PSLD QA procedures, QA needs along with cross-collaborative project work upon TL approval. Have full familiarity with PSLD workflows in order to provide fully accurate quality assurance guidance and feedback as well providing quality assurance insight for developing projects within the plan operation department ad hoc. Responsible for the systematic monitoring and evaluation of the performance of a service to ensure that performance standards are being met, identifying and mitigating risks, reducing costs, and proactively identifying and correcting issues. Oversee and manage the QA team’s performance and assist in developing process improvements, SOPs, metrics, etc to routinely operationalize daily workflows. Quality Assurance focuses on prevention, appraisal, internal failure, and external failure while considering customer focus, leadership needs, engagement of people, process improvement, evidence-based decision making and relationship management. Execution, mentoring, training and compliance with assigned Standard Operating Procedures and controls including mentee compliance. Execution, mentoring, development, and compliance with assigned Standard Operating Procedures and controls including assigned mentor-mentees and team. Maintain close collaboration with identified stakeholder teams working cross functionally. Familiar with the location and detailed knowledge of the content of Knowledge Articles needed to perform assigned Standard Operating Procedures and an ability to mentor others on the content and its application. Involved in the ongoing review of Knowledge articles and an ability to recommend improvements. Manage, support and contribute to projects focused on improving Standard Operating Procedures Understand and react to operational health reporting Client, partner, and stakeholder facing interactions. Conduct and contribute to weekly "office hours" & team working sessions to collaborate on, discuss, and help resolve various issues that are escalated to our team as they arise Identify and review trends and escalations that impact service performance. Preparing root cause analysis and improvement recommendations. Perform 80% of core tasks at an SME level. Subject Matter Expert (SME)- Has mastered the skill. They will be added to the SOPs as a point of reference for questions and guidance. Participate, support, contribute, and recommend Plan Ops and stakeholder team engagement activities Manage escalations in processes and complimentary standard operating procedure in stakeholder teams. Reviewing Standard Operating Procedures that have up and down stream impacts. Manage relationships and escalations with partners. Coordinating complimentary standard operating procedure. Monitoring performance standards, reviewing partner reports and compliance with plan and contract requirements. Work member, client, and partner escalations reporting on their impact to stakeholders. Manage the most complex and most visible projects successfully involving multiple teams and stakeholders, with the audience of these projects being our clients and members. Act as a peer leader on the Plan Design team among the other team members, and step in to act for the Team Lead when they are OOO Ensure that the artifacts delivered meet industry standards Lead the Quality Assurance sub-team on Plan Design, ensuring accuracy for all of our artifacts, especially our high-visibility deliverables Work with the development team to build internal tools to improve processes as we identify and fix problems Collaborate cross-functionally with Plan Operations, Eligibility, Member Claims, Product, Development, Legal, Clinical, Copy, Client Success, and other teams to delight our customers

Requirements

3 years of direct leadership experience in health insurance, healthcare operations, or health benefits administration
You have an extensive knowledge and extremely intuitive understanding of QA procedures and attention to detail
You have strong analytical thinking and problem-solving skills to collect, organize, analyze, and disseminate information with extreme attention to detail and accuracy
You enjoy adding structure & taking a methodical approach to problems
You are a committed team player
You thrive on change and are enthusiastic about being along for the ride and learning from our experiences together
Experience in leading large-scale, complex projects
Experience with developing firm plans of action, especially when a situation is urgent or pressing
Able to communicate effectively and cross functionally as many of our projects and deliverables interact with other teams
Excellent Microsoft Offices or Google Suites skills
Experience partnering and leading teams to deliver project goals
You connect with Collective Health's mission to transform the health insurance experience for employers and their employees
Bachelor's degree

Responsibilities

Review proposals for improvement and provide support for projects focused on improving Standard Operating Procedures and compliance with internal controls and eternal regulations.
Maintain and support overall PSLD QA procedures, QA needs along with cross-collaborative project work upon TL approval.
Have full familiarity with PSLD workflows in order to provide fully accurate quality assurance guidance and feedback as well providing quality assurance insight for developing projects within the plan operation department ad hoc.
Responsible for the systematic monitoring and evaluation of the performance of a service to ensure that performance standards are being met, identifying and mitigating risks, reducing costs, and proactively identifying and correcting issues.
Oversee and manage the QA team’s performance and assist in developing process improvements, SOPs, metrics, etc to routinely operationalize daily workflows.
Execution, mentoring, training and compliance with assigned Standard Operating Procedures and controls including mentee compliance.
Execution, mentoring, development, and compliance with assigned Standard Operating Procedures and controls including assigned mentor-mentees and team.
Maintain close collaboration with identified stakeholder teams working cross functionally.
Familiar with the location and detailed knowledge of the content of Knowledge Articles needed to perform assigned Standard Operating Procedures and an ability to mentor others on the content and its application.
Involved in the ongoing review of Knowledge articles and an ability to recommend improvements.
Manage, support and contribute to projects focused on improving Standard Operating Procedures
Understand and react to operational health reporting
Client, partner, and stakeholder facing interactions.
Conduct and contribute to weekly "office hours" & team working sessions to collaborate on, discuss, and help resolve various issues that are escalated to our team as they arise
Identify and review trends and escalations that impact service performance.
Preparing root cause analysis and improvement recommendations.
Perform 80% of core tasks at an SME level.
Subject Matter Expert (SME)- Has mastered the skill. They will be added to the SOPs as a point of reference for questions and guidance.
Participate, support, contribute, and recommend Plan Ops and stakeholder team engagement activities
Manage escalations in processes and complimentary standard operating procedure in stakeholder teams.
Reviewing Standard Operating Procedures that have up and down stream impacts.
Manage relationships and escalations with partners.
Coordinating complimentary standard operating procedure.
Monitoring performance standards, reviewing partner reports and compliance with plan and contract requirements.
Work member, client, and partner escalations reporting on their impact to stakeholders.
Manage the most complex and most visible projects successfully involving multiple teams and stakeholders, with the audience of these projects being our clients and members.
Act as a peer leader on the Plan Design team among the other team members, and step in to act for the Team Lead when they are OOO
Ensure that the artifacts delivered meet industry standards
Lead the Quality Assurance sub-team on Plan Design, ensuring accuracy for all of our artifacts, especially our high-visibility deliverables
Work with the development team to build internal tools to improve processes as we identify and fix problems
Collaborate cross-functionally with Plan Operations, Eligibility, Member Claims, Product, Development, Legal, Clinical, Copy, Client Success, and other teams to delight our customers