Health Plan Ops, Manager - Austin, United States - Curative HR LLC

Description

Curative is reimagining health insurance - with $0 out of pocket costs and by reducing barriers to people seeking care.

Help us create a better healthcare experience for our members by making it easy & intuitive for them to access the care they need.

We believe in a clear, simple health plan that allows our members to get zero-cost in-network care anytime they need it.

We want to put healthcare back in the hands of the patient and clinicians, with a focus on preventative care.

Essential Functions:
Oversee vendor management for health plan operations including contracting, implementation and process build-out with integration to other teams (i.e. Subrogation vendor, ID cards, etc)

Support process design, training, policies and procedures documentation across Health Plan Ops to promote scalability, support system build-outs and identify leading market service delivery capabilities Lead competitive benefit review and benefit policy documentation across claims, account management and customer service with interface into network, clinical, pharmacy, marketing and compliance teams Drive build-out of provider operations support for service, automated payment (ERA/EFT), provider manuals, and portal development Establish key OKR metrics and tracking across internal and vendor functions Lead and participate in key operations team projects Responsibilities:
Curative is rapidly growing, and is raising the bar in what people expect from their health plan.

We're looking for someone who can think creatively, has attention to detail, and can help us scale an aggressively growing business by making health plan operations are onboarded quickly and accurately.

Through process and data analysis, identify how we can improve our delivery through both internal capabilities and vendors (fraud, waste, & abuse, appeals and grievances, etc)

Document policies and procedures to help drive scalable models and training programs Build our end to end workflows as we scale to deliver 4X membership with a focus on organizational training needs and delivering superior customer, provider, and member experience Assist in benefits design interpretations for market competitiveness and orchestrate operational implementation and ensure regulatory compliance Relevant Experience:
Knowledge of employer group medical health coverage experience across benefit plan design, broker and employer group operations, provider support (manuals, portals) and member experience Ability to oversee programmatic implementations, building processes and scaling operations to deliver on 4X membership growth Knowledge of vendor contracting and performance management Experience working with cross functional teams to document processes, design training, and identify process improvements Preferred but not Required: Knowledge of and experience with claims systems (Health Edge), clinical (Guiding Care) and account management (SalesForce) A strong desire to make healthcare better, to be part of a big change in the health insurance market