Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Program Specialist, ASO Programs

🔍 New York, New York

New

📁: Product Management

💼: EmblemHealth

📅   : 4 days ago Post Date

Summary of Position

Lead the technical implementations for the ASO, Shared Administration and Network Access Programs with Third Party Administrators (TPAs) as required.
Manage the maintenance and enhancement of ASO including Shared Admin and Network Access product offerings.
Collaborate with marketing teams to develop materials and tools that support sales and education efforts.
Collaborate with internal stakeholders to resolve issues related to the needs of the ASO, Shared Administration and Network Access programs.
Provide input on benefit design changes and assist in documenting updates to ensure clarity and consistency for ASO, Shared Admin and Network Access clients.
Partner with Sales/Account management teams by providing expertise of technical documentation, ASO, Shared Administration and Network Access product and process.
Research market trends, competitor products, and regulatory changes to provide insight and support product updates and improvements

Principal Accountabilities

Manage operational processes specific to ASO, Shared Admin, Network Access and Large Group segments.
Work with IT and operations teams to ensure systems are configured correctly for ASO, Shared admin, Network Access and Large Group segments including eligibility, billing, and reporting functions.
Manage the implementation and the technical specifications of ASO , Shared Administration and Network Access.
Monitor any implementation updates related to ASO compliance, including ERISA, ACA, and HIPPA regulations.
Assist in analyzing market trends, client feedback, and competitor offerings to identify opportunities for enhancements.
Contribute to the development of strategies for improvement and growth of ASO product offerings.
Serve as the business SME to internal & external constituents on the ASO, Shared Administration and Network Access programs.
Develop and maintain cross-functional relationships. Engage the appropriate business/operations areas to research issues identified for ASO, Shared Administration and Network Access programs. Assist in resolving escalated client issues related to operational or benefit design challenges.
Manage and respond to large group ASO client questions, offering detailed explanation of plan structures and operational processes.
Lead internal/external conference calls: planning, follow up, meeting scheduling, documentation preparation and call notes distribution.
Manage Sales/Account management teams by providing explanation of the ASO, shared Administration and Network Access programs workflows.

Qualifications:

Bachelor’s Degree.
4 – 6+ years of relevant, professional work experience required
Extensive knowledge of ASO products, funding arrangements, and related services required
Strong understanding of health care regulations (ERISA, ACA etc.) and compliance requirements required
Familiarity with health plan pricing, claims administration and benefit designs required
Experience in claims and EDI transactions (837, 835, etc.) required
Additional experience/specialized training may be considered in lieu of educational requirements required
Self-starter: ability to work on issues without being prompted and seeing issues through to completion required
Detail oriented; analytical and problem identification and resolution skills required
Strong data analysis skills; ability to discern patterns and trends required
Excellent collaboration skills and the ability to influence management decisions required
Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience required
Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required
Knowledge of/proficiency with applicable systems and platforms (FACETS, TruProvider and Salesforce) required
Exceptional organizational and project management abilities to handle multiple priorities preferred

Security Disclosure

If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.

We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail.

Pay Disclosure

A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.