The State of Arkansas is partnering with HHS to operate a State Partnership Exchange. To facilitate this relationship, HHS anticipates that QHP issuers operating in a State Partnership Exchange will have a designated Federal Account Manager, who will serve as a point of contact between the QHP issuer and HHS for questions and issues related to federal activities, such as administration of advance payments of the premium tax credit. The Federal Account Manager will assist QHP issuers by providing policy clarifications and other assistance with the program on an as-needed basis. The Enterprise Exchange Account Representative will serve as our liaison with the Federal Account Manager.
• During the start-up of the Enterprise Exchange Services area, this position will be assigned responsibilities as needed for the Enterprise to successfully participate in the State(s) Exchanges, Private Exchanges, and “off exchange marketing”. These assignments will be at the discretion of the Claims Manager of Enterprise Exchange Services.
• Position will be asked to be an active participant in the Enterprise Exchange Work Groups.
• Responsibilities will be placed on this position that will entail working beyond normal working hours or normal work week, due to the many unknowns of the upcoming Exchange and other Health Care Reform provisions.
• Continuous evaluation of internal processes and operations to ensure maximum efficiency and to forecast and address needs of ABCBS to comply with the PPACA.
• Build and maintain positive relationships and rapport with State and Federal level staff as needed.
• Coordinate and assist in the integration of claims, enrollment, and billing activities interacting with all levels of leadership within BCBSA and the Enterprise.
• Adhere to the standards and guidelines of the Enterprise, Government Agencies, and the BCBS Association in the performance of all duties. The ability to successfully operate in an environment with heavy compliance and regulatory requirements will be mandatory for this position.
The Enterprise Exchange Account Representative must assume a self-directed leadership role, work independently, understand project management methodologies and quality principles, and possess superior communication skills while developing and maintaining diplomatic rapport with all internal staff. Necessary skills require complete and thorough written documentation, presentation skills and effective facilitation of internal meetings with management staff.
Nature & Scope
The Enterprise Exchange Account Representative reports directly to the Claims Manager of Exchange Services. The incumbent works closely with all members Enterprise Exchange staff, other ABCBS management staff, AID and HHS to ensure that our exchange products are managed and supported to the best of our ability. Other assignments may vary broadly in subject matter requiring the incumbent to be knowledgeable in many topics and flexible in order to meet these many needs. The incumbent must rely on their skills in leadership, project management, research and data analysis, problem analysis and solving, organizational planning, group management, statistical measurement, reporting and documentation.
The incumbent must possess excellent communication skills, both oral and written to ensure that a productive and cooperative climate is maintained with all customers internally and externally. The incumbent will be required to present to various committees information as it relates to the customer service division.
Skills, Knowledge and Abilities
1. Excellent working knowledge of quality principles and theories
2. Ability to work in a high stress environment at times with numerous competing priorities.
3. Adept at conflict management
4. Ability to organize workflow for maximum efficiency and maintain detailed, organized records for multiple simultaneous projects
5. Advanced research and reading comprehension skills, able to interpret and develop action plans based on complex and multi-faceted information
6. Ability to gain trust and commitment from others, and to build strategic working relationships.
7. Ability to analyze and draw objective, independent conclusions based on multi-faceted factual and subjective information
8. Strong decision-making abilities, including development of clear action plans, using innovative yet practical methods
9. Ability to adapt action plans based on customer needs and multiple priorities.
10. Ability to confidently, succinctly, and professionally communicate thought processes and conclusions via written and verbal communication
11. Ability to produce quality work under pressure and time constraints
12. Ability to be scheduled for work on short notice and overtime – nights, days, Saturdays, Sundays or holidays – and travel on short notice.
Minimum Job Requirements
1. College degree in Business Administration or related field and project management experience in a professional environment.
Analytical or leadership experience with project management experience in a professional environment.
2. Experience in development of business requirements to support internal processes (will be tested during interview process).
3. Operational experience in customer service, membership enrollment & billing and/or claim processing is highly desirable.
4. Proficient in Microsoft Office Suite applications.
This position is identified as level three (3). This position must ensure the security
and confidentiality of records and information to prevent substantial harm, embarrassment,
inconvenience, or unfairness to any individual on whom information is maintained.
The integrity of information must be maintained as outlined in the company Administrative
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented
or detected on a timely basis by employees in the normal course of business. This
position must adhere to the segregation of duties guidelines in the Administrative
PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES (Essential Functions of Job)
Primary Responsible is to serve as our liaison between the AID and HHS regarding Exchange activities.
2. Serve as point of contact for issuer to address questions and issues related to QHP certification and requirements.
3. Track and prioritize requests from AID, HHS, and internal Enterprise staff.
4. Support project request needs for internal/external Reporting. (Includes claims, membership, and billing)
5. Ensure the Claims Exchange Manager is informed concerning the status of Exchange projects.
6. Contribute to and support the Enterprise strategic and operational planning process to include total quality management philosophies.
7. Assists in testing on special projects and surround processes developed for Exchange Operational Staff.
8. Ensures all assigned tasks are completed by the target dates.
9. Maintains the production systems at the highest levels of efficiency.
10. Interacts with internal and external customers and systems areas in resolving problems and initiates vendor and internal system change requests as appropriate.
11. Ensures that a cooperative and productive climate is maintained with all internal and external contacts.
12. Ensures that the Supervisor and/or Manager are aware of all problems and the action that is being taken to correct the problem(s).
13. Becomes knowledgeable of the enterprise functions to the level necessary to accomplish assigned tasks, including Enterprise Exchange integration initiatives.
14. In conjunction with the Supervisor and Manager, ensures that personal business and professional skills are continuously enhanced to maintain business and technical acumen, commensurate with the rapidly evolving health care industry and technological innovations/developments.
Arkansas Blue Cross and Blue Shield
- 2 years ago - save job