Jobs

    Vice President, Health Plan Operations - Texas, United States - Texicare

    Texicare
    Texicare Texas, United States

    3 weeks ago

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    Description

    As the leading provider of workers' compensation in the state, Texas Mutual is trusted by businesses, many of which are small businesses. Texicare, Texas Mutual's new health care subsidiary, is dedicated to transforming the limited options available to small Texas businesses and their employees. We're looking for passionate, committed individuals who share our vision and are ready to join us as we lay the foundation for an important improvement in health care coverage.

    In the Vice President, Health Plan Operations role, you will support the success of the organization by serving as the responsible for and oversees activities supporting Medical/Pharmacy Claims, Call Center Operations, Complaints, Appeals and Grievances for Texicare. You will be responsible for collaborating on the design, development and implementation of initiatives that advance objectives of Texicare while ensuring compliance with any state and federal regulatory requirements. You will coordinate and collaborate closely with the Executive Leadership Team and will report to the COO.

    In this role, you will:

    · Own end-to-end claims, call center, benefit administration, quality assurance, COBRA, and PBM management

    · Work in an entrepreneurial environment, building ground-up processes and operational teams that are scalable depending on need.

    · Set, monitor, and optimize operational performance metrics and develop on-going continuous improvement plans for partners

    · When monitoring vendor partners, ensure that corporate service level agreements (SLAs) are met or exceeded

    · Oversight and administration of claims activity, including claims adjudication, appeals, quality measurements, coordination of benefits, pre- and post-audit activities, and overpayment recovery activity

    · Responsible for ensuring compliance with TDI, CMS, ERISA, HIPAA, and any other applicable regulatory and industry requirements.

    · Maintains a comprehensive understanding of covered benefits, coding, reimbursement policies, contracts, and rates

    · Tracks and trends efficiency and financial metrics and reports out regularly to senior leadership

    · Represents the organization for delegated entities to negotiate terms and contracts in support of the operating principles and practices and short- and long-term needs of the organization.

    · Oversees 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)

    To be successful in this role, you should have:

    · 15 or more years of experience in healthcare industry

    · Minimum of 5 years' experience in a director level operational management role

    · Bachelor's degree in business or related field

    · Experience in strategic planning, organizational development, budget and resource development.

    · Demonstrated ability to lead and motivate a team, foster a collaborative work environment, and drive operational excellence

    · Technical and financial understanding of health care operations

    · Effective communication, problem-solving, and analytical skills

    · Strong work ethic and dependability; take on broad new challenges

    · MBA or MHA (preferred)

    Benefits:

    · Automatic 4% employer contribution to retirement plan

    · 401k plan with 100% match up to 6%

    · Flexible time off for vacation, illness, etc.

    · Nine paid holidays

    · Day one health, Rx, vision, and dental insurance

    · Life and disability insurance

    · Flexible spending account

    · Pet coverage and pet Rx discounts

    · Free identity theft protection

    · Free 2nd medical opinion service

    Texicare is an Equal Employment Opportunity employer.

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