Group Setup Specialist IV, Sold Plan Validation

Group Setup Specialist Iv, Sold Plan Validation

In addition to the responsibilities listed below, this position is also responsible for: reviewing group installation drafts to ensure accuracy in accordance with Sarbanes-Oxley (SOX) control narratives; providing data and information needed to perform internal and external audits; supporting internal and external audits that require the auditing of customer and contract data attributes against sources of truth; participating in SOX control narrative updates as needed; and resolving issues in group renewals and installations that implicate SOX controls.

Essential Responsibilities:

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Coordinates efforts across teams by: collaborating with partner teams (e.g., sales, account management, case installation, benefits, underwriting, membership administration) to effectively translate purchase information into data attributes and prepare the system for new member enrollment; and troubleshooting issues with relevant partners as they arise to ensure efficient Group Setup processes.
• Compiles and applies departmental data by: analyzing and translating data for various audiences and advising stakeholders (e.g., sales, case installation) of system performance issues and patterns where submissions are nonconforming or inaccurate; and tracking status of complex groups or key accounts in setup pipeline and updating stakeholders as needed;
• Improves member satisfaction by: analyzing nonstandard member feedback/issues and driving larger-scope improvement processes that involve multiple teams/markets to enhance Group Setup processes;communicating with customers/group respresentatives to ensure understanding of administrative details and educating them on Membership Administration policies and procedures that impact installation decisions; and providing quality customer service through communication with groups and members.
• Prepares system for new member enrollment by: entering and translating contractual information (e.g., product, plan, administrative details) associated with a sale and provided by the sales team into data attributes that are available in the membership system; identifying gaps or inconsistencies in group purchase and renewal submissions and collaborating with partners (e.g., sales, case installation) to resolve issues; developing moderately complex structures and substructures in the system to accurately and comprehensively capture membership criteria; reviewing purchase details to ensure accuracy and completeness of contract provisions; performing system testing for new products, system changes, and other customer/contract updates and addressing identified issues; and informing partners (e.g., sales, case installation) and serving as a resource on best administrative approaches to achieve group/employer needs and requirements.

Minimum Qualifications:

• Minimum one (1) year experience working with SOX internal controls.
• Minimum one (1) year of experience in a leadership role with or without direct reports.
• Minimum one (1) year of experience in health plan operations.
• Bachelors degree in Business, Health Care Administration, Operations Research, Public Health Administration, Finance, or related field AND minimum three (3) years of experience in compliance, financial insurance, health care administration, or a directly related field. OR Minimum six (6) years of experience in compliance, financial insurance, health care administration, or a directly related field.

Additional Requirements:

• Knowledge, Skills, and Abilities (KSAs): Information Gathering; Systems Thinking; Business Acumen; Negotiation; Business Process Improvement; Operations Management; Risk Management; Written Communication; Commercial Customer Quality; Compliance Management; Health Care Policy; Maintain Files and Records; Data Entry; Union Partnerships; Advising and Managing Partners; Company Representation; Consulting; Corporate Partnerships; Stakeholder Management; Crisis Management; Mentoring and Coaching; Coordination; Incident Escalation; Key Performance Indicators; Managing Complexity; Risk Assessment; Service Focus; Computer Literacy; Accountability; Autonomy; Stress Tolerance; Member Service; Insurance Coding; Insurance; Insurance Regulations, Policies, and Procedures; Insurance Contracts; Underwriting; Quality Improvement; Customer Satisfaction; Health Plan Operations; Health Insurance Products; National/Multi-~State Sales and Account Management; Business Operations; Business Planning; Project Management

Preferred Qualifications:

• One (1) year experience evaluating internal controls or auditing experience.