Immediate need for a talented Relationship Coordinator. This is a 06+ Months Contract opportunity with long-term potential and is located in Philadelphia, PA (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID:24-44289
Pay Range: $28 - $30/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
Works as a liaison between clients for all lines of business and products such as Preferred Provider Organizations (PPO), Traditional, Medicare Advantage, Health Maintenance Organizations (HMO), Medicare Supplement, Medicare Cross-over in order to resolve problems related to service delivery, claims processing and procedural issues.
Resolves common, complex and escalated issues directly impacting client Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or directly with internal business teams.
Tracks issues, provides root cause analysis and escalates to Management enabling issues to be addressed at a National level.
Partners with all areas of company, especially the various client provider teams to achieve timely issue resolution and compliance with other BCBS Health Care Plans' benefits requirements.
Takes ownership of resolving a partner plan inquiry from start to completion, including when an issue requires assistance of another internal area.
Acts as a liaison between Client and all partner BCBS Health Care Plans to ensure end to end resolution of issues for all claims in accordance with the Inter-Plan Program (IPP) requirements.
Identifies and aids in establishing business requirements for system updates/changes to eliminate "operational" issues that are identified as trends/patterns of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms.
Collects information related to issues and provides recommendations for educational material for the client provider community, especially where it concerns Host claims policies and processing.
Able to effectively use Internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory both onsite and offsite to meet stringent BCBS Association requirements.
Receives tracks and research Director level and above escalations for timely resolution in accordance with BCBSA escalation guidelines.
Demonstrated leadership, information driven decision-making, problem solving, organization and planning skills are essential to be successful in this position.
Effective presentation and communication skills, both oral and written are essential.
Ability to interact effectively with Providers/Partner Plan Staff at all levels and client associates at all levels, and across all departments.
Must be able to work efficiently in a team environment as well as individually.
Key Requirements and Technology Experience:
Skills-Blue Card experience, Claims/Service operations environment and Inter-Plan policies.
High School Diploma or GED ,4 years' experience in a Claims/Service operations environment OR.
A bachelor's degree, 2 years' experience in Claims/Service environment.
Demonstrated understanding of Inter-Plan policies, processing standards and guidelines to include Host and Home responsibilities.
Demonstrated understanding of all Inter-Plan Systems.
Demonstrated understanding of Products to include Medicare Advantage, Medicare Cross-over, State Health Plan, Administrative Services Only (ASO) and Fully insured and Individual products, National Accounts Database.
Experience in the development, design and execution of account specific, customized education programs in the health care industry is preferred.
Our client is a leading Health Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.