For more than four decades, Trustmark Health Benefits has designed integrated, flexible, and tailored employer health plan designs that seamlessly meet specific business needs and delight members. Each of our offices around the country are managed locally, by industry veterans who understand the dynamics of the markets they serve. Our responsive and empathetic service teams provide the highest level of support for employers and members. Our local expertise and service represents our national strength. We are an independently operated subsidiary of Trustmark Mutual Holding Company.
THIS POSITION CAN BE ENTIRELY VIRTUAL/REMOTE/WORK FROM HOME AND THE INDIVIDUAL CAN SIT ANYWHERE IN THE US.
POSITION OVERVIEW: This position is responsible for leading and overseeing multiple teams to ensure excellence in claim management, oversight, and administration. Responsibilities include, but are not limited to, successful achievement of client/corporate key performance indicators, service level agreements, staff development and succession planning. In this role, you will work collaboratively with leadership and front line staff to ensure strategic direction, consistent operations, and functional business platform is maintained across all locations and staff.
RESPONSIBILITIES:
Coordinating and Executing Deliverables
- Strategically plan, and manage, monitor, track and report performance of the department(s), outsourced vendor and support staff to ensure that exceptional service is achieved on key performance indicators. Oversee delegation of work and adjust plans as needed based on staff availability and business need.
- Oversee related functions and/or support functions, as needed.
- Ensure consistency of service deliverables through collaboration with Customer Service Department peers as well as regular communication and leadership of staff.
- Collaborate with Operations Leader in strategic planning, budgeting, and expense control.
People Leadership and Development
- Oversee or handle personnel matters including mentoring, coaching, motivating, performance management and feedback, recognition, performance evaluation and time tracking of direct and indirect reports.
- Recommend compensation and promotion increases.
- Establish and effectively communicate department goals, objectives, culture and expectations.
- Mentor and develop leaders within the team as well as ensure that those leaders do the same with their staff.
- Collaborate with team to determine staffing needs and succession plans, and take or delegate appropriate action.
- Oversee onboarding and training of new staff and newly promoted staff. Assess ongoing training and development needs and provide opportunities for improvement, as needed.
Claim Management and Support
- Handle increasingly complex claim referrals and over-authority claim audits using internal and external resources as needed. Advise staff or vendor regarding claim processing.
- Oversee resolution of client, member, or provider issues regarding highly visible and increasingly complex claim or service issues.
- Effectively communicate and advise staff on client benefits and unique client handling to ensure proper claim processing. Oversee User Testing to ensure benefits are set-up correctly.
- Oversee review of state/federal legislative and regulatory requirements to determine impact on claim practices. Update and/or implement procedures or documentation, as required.
- Oversee client-initiated audits of processed claims and claims procedures.
- Ensure Appeals are maintained with compliance standards
Enterprise Collaboration and Leadership
- Serve as a change agent and leader within the organization to ensure a positive work environment and adherence to corporate values.
- Assist in establishing and maintaining the culture within Claim Operations.
- Collaborate with staff, as well as enterprise to develop effective policies and procedures. Ensure they are implemented timely and maintained effectively.
- Participate in enterprise wide work teams and projects. Include staff as needed for both their input and development.
- Present recommendations and make decisions on project teams and in meetings on behalf of department.
- Ensure data sets are monitored for staffing, performance, and accurate claims management
QUALIFICATIONS:
- Strong intellectual curiosity
- Bachelor’s Degree or 10+ years of related business experience
- 7+ years of medical claims experience in the healthcare/benefits arena
- 5+ years previous management experience
- Strong leadership competence, with proven skills in managing change
- Strong interpersonal and collaboration skills with ability to build consensus and develop solid relationships
- Takes initiative, plans and executes plans well,
- Strategic thinker with ability to multi-task, prioritize, handle pressure and make informed decisions
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, or disability.
Required Skills
Required Experience