Senior Business Lead, Carrier Operations

Senior Business Lead, Carrier Operations

Position Summary

This position has primary responsibility for the overall vendor management of an assigned group of Trust health care plans. This includes providing subject matter expertise, ensuring the accurate and efficient delivery of Trust benefits, interfacing with third party carriers and vendors to effectively manage plan operations.  Work involves the ability to coordinate cross-functionally to research, recommend and facilitate solutions and decisions within the limits of the UAW RMBT policies and procedures relative to the UAW RMBT health care benefits. This may include, but is not limited to eligibility, benefit coverage, claims, payment, appeals and policy interpretation.

·       Under the direction of an Officer, Senior Director, or Director is accountable for an identifiable benefit, healthcare, or customer service program of the trust.

Essential Functions

      1.    Provides overall vendor management and day-to-day operational oversight of all assigned plan. 

      2.    Identifies and presents opportunities to enhance and align benefit plan design and business processes. Leads implementation of benefit changes with plans on an annual and ongoing basis, as needed.

      3.    Serves as a key contributor to the annual renewal project, including carrier plan renewals and related contracts/amendments, carrier-related deliverables for Alight, documentation of plan change requirements, and operational readiness planning.

      4.    Coordinates the carrier development and internal department reviews of member-facing communications, including benefit plan design documents, materials for prospective and new members, and information related to resources and programs.  

      5.    Participates in the evaluation of carrier and vendor programs and pilots designed to improve overall performance of plans. Coordinates activities related to implementation, transition to steady state, and monitoring of engagement and results.

      6.    Partners with internal and external resources to develop and maintain benchmarking and reporting mechanisms, including operational metrics, cost and use, and plan performance dashboards. Supports Trust information technology and business intelligence resources regarding data integrity efforts and enhancements.  Assures consistent monitoring, management and reporting on vendor contractual and service level obligations.

      7.    Identifies operational issues and challenges, completes root cause analysis, and recommends comprehensive solutions to improve efficiency and mitigate risk. Works with plans to implement required changes related to compliance with legislative and regulatory items.

      8.    Provide support to external audit team and carrier resources for annual claim audits, pre- and post-implementation testing, and related actions to resolve findings, as applicable.

      9.    Effectively coordinates and collaborates with other Trust departments and functions – including member experience, strategy, population health, pharmacy, communications, eligibility, external audit, business intelligence, information technology and finance.

  10.    Attends and presents at off-site member meetings, as necessary.

This list details the Trust’s assignment of essential functions to this position. Other duties or tasks may be assigned to this position. This job description is subject to change at any time.

Technical Competencies

• Extensive knowledge of retiree health care benefits (including medical, dental, vision and hearing plans), Medicare, and self/fully-insured funding arrangements
• Strong knowledge of the healthcare marketplace and Medicare plans
• Clear understanding of CMS advanced notice process, STARS ratings, and quality metrics for Medicare Advantage plans
• Strong analytical, writing, and organizational skills
• Strong experience in managing complex projects
• Proven negotiation skills and experience with complex contracting and vendor management situations
• Ability to develop solutions to unusual situations and unique opportunities
• Ability to articulate and present health care information to non-health care audience
• Proficient in Microsoft Office applications (Excel, Word, and PowerPoint)

Leadership Competencies

Leaders of the Trust are expected to demonstrate relevant leadership competencies as specified in the Trust’s competency definitions.

Personal Effectiveness Competencies

All employees of the Trust are expected to demonstrate relevant personal effectiveness competencies as specified in the Trust’s competency definitions.

Minimum Required Experience

• 7 – 10 years of experience directly managing a group-sponsored healthcare benefit plan
• Experience with employee / retiree benefits, health care services, health care / employee benefits consulting, or related fields
• Demonstrated project management and vendor management experience

Education, Professional Certifications and Licensure

• Bachelor’s degree in Health Care or Business Administration required.
• Master’s degree preferred.

Working Conditions and Physical Effort

• The physical requirements of this position are typical of office work.
• Some seasonal travel required.