Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net, through its subsidiaries, provides and administers health benefits to approximately 5.4 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 4.9 million individuals, including Health Net's own health plan members. Health Net's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website at
This position is responsible for daily operational interface with Blue Cross/Blue Shield South Carolina (BCBSSC) staff and management on business, technical, financial and contractual matters. The purpose of the interface will be to oversee ongoing operations in order to provide direction and guidance to BCBSSC to ensure that performance is compliant with their subcontract with Health Net Federal Services and HNFS' prime contract with the government.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Serve as liaison between HNFS operational and management staff and BCBSSC staff.
- Generate and review frequent (i.e., daily, weekly, monthly, quarterly) performance reports and investigate and resolve any anomalies.
- Chair, facilitate, and/or attend frequent (i.e. weekly) status meetings with BCBSSC operations and technical staff and will work with participants to facilitate a continuous, open exchange of information.
- Evaluate, interpret, analyze data and or business processes. Develop recommendations and alternatives for management review and presentation.
- Disseminate and/or interpret subcontractor operations information and data across departments and organizations. Assume responsibility for data integrity among various internal groups and between internal and external sources.
- Participate in the review and implementation of all prime contract change orders impacting BCBSSC performance. This may include the review and audit of BCBSSC business, technical and pricing documentation.
- Conduct various studies that may include: 1) analyzing, reviewing, trending, presenting information for management needs; 2) supporting operational activities; 3) developing, enhancing, maintaining budget or financial planning models; 4) surveying and benchmarking. Associate will evaluate and present data to HNFS management.
- Develop or assist in the development of department objectives, goals, policies, procedures, controls and budgets. May assist in the training of new associates.
- Host government representatives during on-site visits. Periodic travel to Sacramento, CA, Columbia, SC, Denver, CO and other locations as required.
- Additional duties as assigned
Bachelor's degree in business or related field
Six years of operational experience, with minimum three years in a management role, in a health care organization and direct experience with health care claims processing
Knowledge, Skills & Abilities:
- Knowledge of proposal development procedures in support of government contracts
- Detailed knowledge of managed health care claims processing and operations
- Excellent verbal and written communications skills
- Interpersonal skills and analytical skills
- Detailed knowledge of Microsoft software products to include MS Word, Excel, and Access
- Database report generation experience preferred
- Demonstrated analytical, leadership, change-management and decision making skills
- Ability to manage and develop associates
The following section describes the general physical requirements for this position. Please note that 'constant' refers to more than 81% of time; 'significant' refers to 40-80%;and 'moderate' refers to 20-40% of the time.
- Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
- Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
- May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
- May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
- Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
- Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
- Required to have hearing ability to receive detailed information through oral communication.
- Required to have speaking ability to express or exchange ideas.
- Constant computer usage including typing and/or eye strain.
- Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
- Moderate phone usage; headsets may be required.
- Moderate travel may be required between work sites and/or out of area.
- Moderate lifting may be required.
May need to lift, carry and/or move equipment/supplies weighing up to
pounds, always using safe lifting techniques.
- Constant work in a loud office environment with frequent interruptions/distractions.
- Constant sedentary work (desk bound or seated).
- Constant reading is required via computer screen and/or bound printed materials.
- Moderate walking/standing may be required.
Walking and/or transporting supplies and equipment between buildings/parking lots and structures may be required.
- Constant concentration may be required on various subjects by listening, reading and thinking clearly.
- Constant interaction with others may be required.
May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
- Constant thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one or several things to the next.
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
Health Net - 30+ days ago