Manager, Reporting

Exemption Status:

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Let's change healthcare together!

At Verdegard, we're revolutionizing the healthcare landscape for small to mid-size employers by providing accessible, high-quality, and easy-to-use healthcare plans coordinated with our internal companies. Drawing from deep experience working with small to mid-size employers, Verdegard delivers plans crafted specifically for their individual needs, by providing cost saving solutions for employers.  Our goals are ambitious, and we're already making waves. Through our innovative solutions, we empower businesses to offer competitive benefits packages that improve the lives of their employees and their families. By joining our team, you'll have the opportunity to make a tangible impact while honing your skills alongside a supportive and talented group of professionals.

Position Summary: 

Supervises all aspects of the Stop Loss and Reporting groups. Manages day-to-day operations of the Stop Loss and Reporting groups to ensure that department staff are properly trained and supervised in order to provide the highest quality of customer service to members, client contacts, carriers. Ensures that Stop Loss and Reporting staff are properly trained and supervised in order to perform all necessary duties to file and resolve stop loss claims and timely and accurately produce standard and custom reporting in compliance with performance standards.  Works under limited supervision.  Relies on experience and judgment to plan and accomplish goals.  Oversees and supervises the work of others.  A wide degree of creativity and latitude is expected.

Essential Duties and Responsibilities include the following:

• Supervise a team of stop loss and reporting analysts, providing guidance, support, and training as needed.
• Establish stop loss and reporting department workflows, processes, and procedures to ensure timely and accurate filing of stop loss claims and production of standard and custom reporting. Prioritize stop loss claims and certain reports to ensure Verdegard meets contracted deadlines.  Coordinate departmental resources and monitor deadlines to ensure Verdegard meets performance guarantees.  Develop and provide reports to management on stop loss and reporting activities to include timeliness and accuracy in filing and resolving stop loss claims and reporting production.
• Ability to read and understand stop loss contracts and apply concepts to daily operations to meet contractual requirements.
• Assist staff in resolving difficult or complex stop loss and reporting situations, including researching and calling members, providers, vendors, or clients when necessary.
• Assist staff with stop loss claims filing and reporting production when necessary.
• Interact and partner with other departments, internal department staff, clients, and other external representatives to resolve stop loss and reporting related issues and ensure that the unit meets service commitments.  Research and respond to requests and inquiries from clients and others.
• Conduct routine audits of filed stop loss claims as dictated by client performance guarantees and company procedures.
• Organize and facilitate monthly staff meetings to develop team members and provide them with new information, updated techniques, revised objectives, and rewards and recognition as appropriate.

Education and Certifications:

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; Respond promptly to client needs; solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients; Manage difficult or emotional client situations.

Supervisory Responsibilities

Directly supervises employees who file and resolve stop loss claims and produce standard and custom reporting. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.  Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. 

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

Bachelor's degree from four-year College or university; 5+ years related experience in Stop Loss Reporting; or equivalent combination of education and experience; 3+ years supervisory experience in stop loss and reporting preferred.  Prior TPA, healthcare, or managed care experience preferred.

Computer Skills

Proficiency with MS Windows Office programs, including MS Word, Excel, and Outlook to create complex documents, manage schedules, and analyze data.

Other Skills and Abilities

• Strong knowledge of medical terminology, contract application, data interpretation and industry standard practices. 

• Demonstrated ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.  Demonstrated ability to meet or exceed the competencies as listed.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.  Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills  

Ability to calculate and apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Results-Oriented Management - Translates vision and objectives into concrete action steps, sets priorities for use of resources by focusing on actions with optimal impact for the business, identifies obstacles to plans and takes steps to resolve them, communicates and implements realistic, effective plans with clear objectives and milestones.

Team Leadership - Fosters teamwork by clearly communicating goals and direction, building team spirit, encouraging positive working relationships, and encouraging individuals to take on new roles that draw fully on their talents.

Mentorship - Encourages people to develop their talents and pursue their goals, gives people opportunities to take on new roles and responsibilities when appropriate, offers constructive feedback, helps the individual construct a career development program following up as appropriate, and puts people in contact with others and with resources that will help them develop further.

Professional Knowledge - Is knowledgeable about the business, possesses relevant job-specific and technological expertise, clearly understands the organizational structure, handles office politics well, and displays financial acumen.

Customer and Quality Focus - Actively demonstrates a personal concern for understanding client needs, ensuring the quality of products and services, maintains a high level of customer satisfaction, and contributes to continuous improvement of products and processes.

Problem Solving - Analyzes problems logically to identify root causes, seeks input from a wide range of sources, asks insightful questions and formulates effective solutions.

Communication - Expresses self clearly and effectively in face-to-face interactions, presentations and written documents, and employs active listening skills to ensure productive interactions.

Interpersonal Effectiveness - Demonstrates good people skills by showing a commitment to teamwork, resolving conflicts effectively and with respect for others’ viewpoints, respecting differences and building strong relationships and networks.

Initiative - Proactively gathers and analyzes information, assesses situations and identifies challenges and opportunities, sees what needs to be done and takes appropriate action.

Adaptability - Adjusts quickly to evolving situations by integrating new information, remaining flexible, recognizing and implementing necessary changes and taking advantage of opportunities presented by new developments.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear.  The employee is occasionally required to stand and walk.  The employee must occasionally lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  While performing the duties of this Job, the employee is in an office setting and is exposed to moderate noise (examples: business office with computers and printers, light traffic).

Working Hours

This is an exempt level position requiring one to work the hours needed to get the job done.  Therefore, one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or holidays as required.  This may be changed from time to time to meet the needs of the business. 

Travel

This position requires travel a minimum of 10% of the time.  Also, attendance may be required at various local training sessions and/or meetings.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.