Health Insurance Operations Manager jobs in Rhode Island

Faulkner Consulting Group is seeking a Manager, Plan Strategy to join the HealthSource RI (HSRI) Team to develop and implement HSRI’s innovative plan design strategy and serve as the main point of contact for all health and dental insurance carriers. The right candidate will work with the Director of Policy & Applied Research to critically assess opportunities and risks and to drive innovative solutions with respect to customer enrollment, retention, access and affordability. Under the direction of the Director of Policy & Applied Research, this position will assess local and national changes that could impact Rhode Island’s individual and small group markets and offer proactive analysis and understanding to help position HSRI or to inform inter-agency work and/or collaboration.

This position is additionally responsible for the day-to-day management of HSRI’s Qualified Health Plan (QHP) product offerings and will oversee the plan certification cycle for HSRI, including instructions and guidelines for carriers, review and approval of carrier submissions, and implementation of approved plans. The Manager, Plan Strategy will ensure the integrity and success of plan management efforts required for the sale of individual and small group QHPs through HSRI’s web applications, serving as a key liaison between HSRI’s plan management, policy, and operations teams, as well as our technology, carrier, and governmental agency partners. The position reports to HSRI’s Director of Policy & Applied Research, with opportunities to engage with a variety of functional teams and leadership at both HSRI and various external stakeholders. (e.g., insurance carriers, technology and business vendors, various state and federal agencies).

Key responsibilities:

Plan Strategy and Innovation

· Act as the subject matter expert (SME) in design and implementation of new initiatives, and identification of policy needs and revisions from carrier viewpoint

· Supports review of updates to state and federal laws and regulations that pertain to HSRI’s work with carriers

· Work with leadership and carriers to develop and implement HSRI’s plan strategy and offerings

· Identify emerging trends, new regulatory requirements, consumer needs/gaps in existing plans

· Work with carriers and other stakeholders to design new plan benefits and/or innovative plans

· Support implementation of RI’s 1332 waiver, including program development, collaboration with carriers and the Office of the Health Insurance Commissioner (OHIC), and required reporting.

Carrier Relationship Management

· Represent HSRI as a relationship manager for medical and dental carriers for any operational, customer service, or plan-related issues

· Works with Director of Policy & Applied Research to build strategic relationship with carriers to better achieve HSRI’s goals

· Keep carriers informed and solicit feedback on HSRI policies, procedures, and public materials

· Assist other teams in resolving challenging operational issues with carriers

Plan Management

· Manage the plan certification cycle for HSRI, including instructions and guidelines for carriers, review and approval of carrier submissions, and implementation of approved plans

· Serve as the key point of contact for OHIC throughout the joint plan review process, including review and analysis of carrier submissions

· Manage the implementation of carrier plans, including data review, template generation, quality control, and coordination with HSRI partners that use plan data

· Serve as point of contact for the Centers for Medicare & Medicaid Services (CMS) for plan management and other carrier-related requests

Carrier Operations

· Serve as the liaison between carriers and HSRI team. Including operational issues, reporting, and data collection

· Coordinate carrier open enrollment activities including plan training, plan testing, and customer service support

· Collaborate with HSRI operations team on the relevant technology changes including release scheduling and carrier testing for enrollment and payment file transactions

· Assist in the development and implementation of all special projects requiring carrier involvement

Qualifications/Requirements:

· Bachelor’s degree

· Minimum 10 years professional experience or a commensurate combination of relevant education and work experience.

· Minimum 2.5 years of relevant experience in health or dental insurance product design, health insurance exchange plan management, and/or project management;

· Experience working at or with health insurance carriers, health care delivery systems, and/or health care focused government entities a plus

· Experience working in a highly matrixed and complex organization

· Proficiency in Microsoft Office; advanced knowledge of Excel strongly preferred

Competencies:

• Ability to foster strong relationships with partner organizations

• Thrives in a detail oriented, deadline driven, multi-faceted environment

• Ability to manage a varied and prioritized task list without compromising quality

• Self-motivated, able to work independently

• Proven ability to meet deadlines

• Organizational skills, with a strong attention to detail and clear, timely communication

• Team player with the ability to build collaborative relationships across the organization

Work Environment:

The Manager, Plan Strategy will be employed by FCG as part of our team at HealthSource RI (HSRI), the state’s marketplace for health insurance coverage. This position will work a minimum of Tuesdays and Wednesdays in the HSRI offices in Providence and the balance virtually from home. The incumbent must maintain normal and consistent work hours, Monday – Friday.

Job Type: Full-time

Pay: $100,000.00 - $110,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Free parking
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Referral program

Experience level:

• 10 years

Education:

• Bachelor's (Required)

Work Location: Hybrid remote in Providence, RI 02908