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Delegation Oversight Coordinator - Work From Home

Role overview

Qualifications

  • Bachelor's degree in Business or Medical OR 4 or more years' experience in a managed care environment
  • 4 years in a leadership role that includes direct accountability and responsibility and direction of staff
  • 4 years’ experience in directly performing delegated oversight activities
  • Project Management skills and experience

Responsibilities

  • Creating, managing and reporting processes to monitor and evaluate activities and functions delegated to contracted entities and vendors
  • Monitoring timeliness of all claims, accuracy of payments and denial ratios
  • Conducting quarterly and annual financial accuracy audits
  • Ensuring compliance with corporate and regulatory/accreditation requirements and standards

Key facts

Other skills

  • Leadership
  • Communication
  • Organizational Skills
  • Customer Service
  • Microsoft PowerPoint
  • Problem Solving
  • Teamwork
  • Time Management

About the company

Health Care Service Corporation logo

Health Care Service Corporation

Health Insurance (Payers)

Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is an Independent Licensee of the Blue Cross and Blue Shield Association. We are the largest customer-owned health insurer in the United States, serving more than 18.6 million members through our Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our futureβ€”driving innovations that further expand access, improve health outcomes, and reduce costs. Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry. As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization: HCSC.com/careers. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to an inclusive, drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability, or protected veteran status.

Company details

Company typeXLarge
IndustryHealth Insurance (Payers)
Company size10001

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Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for creating, managing and reporting processes designed to monitor and evaluate activities and functions delegated to contracted, delegated entities and vendors for assigned products and business lines according to all corporate and regulatory/accreditation requirements and standards. This person will also monitor timeliness of all claims, accuracy of payments and denial ratios, as well as quarterly and annual financial accuracy audits. Ability to travel (as business need arises; within assigned territory; less than 10%).

Required Job Qualifications:

  • Bachelor's degree in Business or Medical OR 4 or more years' experience in a managed care environment.

  • 4 years in a leadership role that includes direct accountability and responsibility and direction of staff.

  • 4 years’ experience in directly performing delegated oversight activities.

  • Project Management skills and experience.

  • Knowledge of regulatory/accreditation requirements and standards (TDI, NCQA, URAC).

  • Verbal and written communication skills.

  • Organizational skills and the ability to handle multiple priorities.

  • PC proficiency to include Word, Excel, PowerPoint and Lotus Notes.

  • Ability to travel.

Preferred Job Qualifications:

  • Knowledge of Power Point and Visio.

  • Customer service experience (call scripts, call metrics, identify callers for PHI security, resolving inquiries, protocol adherence, etc).

  • Tele-sales experience (State Department of Insurance regulations adherence).

  • Polished and professional email and phone etiquette; customer service minded

  • Ability to work under strict regulations and timelines

  • Ability to navigate multiple projects with varying deadlines

Sponsorship will not be provided for this role.

This is a Telecommute (Remote) role.

#LI-LI1

#LI-Remote

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location.

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Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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