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- Manage the execution and coordination of all internal regional business processes related to the Request for Proposal (RFP).
- Lead and drive the request for status quo, alternate and moderately complex renewals for National Account customers.
- Ensure all alternate benefit requests meet regional benefit requirements and state and federal regulatory requirements; if alternate benefit requests do not meet regional/state/federal requirements make recommendations to the Regional Account Manager (AM) and on strategy and/or planning calls, as appropriate, in alignment with strategy.
- Execute, as necessary, any regional processes required for benefit exceptions if requested.
- Partner and collaborate with regional and National Underwriting (UW) and follow regional processes in support of getting rates for status quo and alternate benefit requests.
- Partner with National Proposal Development (NPD) and Underwriting (UW) to ensure benefits and rates are accurate.
- Escalate any concerns for meeting critical deadlines to Regional Account Management (RAM) and National Account Team in a timely manner.
- Audit final RFP submission documents for accuracy and completeness. Escalate as necessary and/or secure RAM approval.
- Confirm that regional global benefit changes are included in RFP submission.
- Hold critical functional partners accountable to meet deadlines and escalate to RAM as needed.
- Manage execution of all internal regional business processes related to the Summary of Benefits and Coverage (SBC) for Fully Insured AND Self-Funded KP Account business.
- Distribute complete and accurate final SBC to National Account Team.
- Act as central point of contact for regional SBC follow-up questions.
- Validate benefits and cost shares on draft SBC document received from regional SBC teams.
- Hold critical functional partners accountable to meet deadlines and escalate to NA Regional AM as needed.
- Lead and manage the execution of all internal regional business processes related to Confirmation and Installation Seasons.
- Review and validate the accuracy of the final confirmed provisions and rates template.
- Execute regionally required processes to begin installation of sold renewal.
- Responsible for managing, updating and collaborating with NAAMs to ensure an accurate Standardized Account Structure template is available in each region.
- Partner with Case Installation when they are assigned (including Expert Team Meeting call).
- Conduct regional clean-up/audit of unsold custom benefit builds as confirmations are received.
- Hold critical functional partners accountable to meet deadlines and escalate to RAM in a timely manner as needed.
- QA and submit documents that inform what goes into regional membership systems ensuring cross-functional down-stream partners have accurate documentation to be able to generate critical documents.
- Complete comprehensive QA post-installation to ensure all downstream (internal and external) outcomes and experiences are positive, mitigate re-work, reduce potential investments, and ensure excellent member experience at the point of service.
- Provide excellent service; pursue exceptional outcomes; deliver timely and accurate resolution of requests; and act as a collaborative influencer utilizing effective communication.
- Serve as responsible party and central point of contact to collaborate with internal functional partners to research and resolve member/customer inquiries or issues.
- Consult with Regional AM to resolve internal inquiries or issues when internal partners are compromising the quality of work.
- Serve as the primary point person for National Account Team and internal partners if RAM is in the field.
- Partner with Underwriting to assist in resolving rate issues; complete root cause analysis and communicate/share learnings.
- Manage regional processes and complete necessary documents to execute activities for group breakaways and break-ins.
- Lead and drive all processes and appropriate documentation for group merger, acquisition, and transfer activity resulting in a seamless transition for groups, consultants, and members.
- Train and mentor new Regional AAM staff.
- Minimum of three (3) years account service experience and/or case installation/implementation within the health insurance industry.
- Minimum of one (1) year of project/program management experience.
- Bachelors degree in business administration or health care administration or related degree OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
- N/A
- Technical experience in on or more of the following areas: provider billing, claims administration, provider relations, provider contracting, revenue cycle finance, and data analytics.
- Experience working with large groups/National Accounts.
- Broad knowledge of health insurance market.
- Knowledge of health plan administration and operational needs for complex health insurance products, including self-funding and private exchange.
- Strong interpersonal skills.
- Proficient in all Microsoft Word programs.
- Technically savvy - comfortable working with a diverse number of systems and tools.
- Strong time management and organizational skills.
- Able to manage multiple moderately complex high demanding priorities.
- Comfortable working within a team environment that requires consistent process management.
- Five (5) years account service experience and/or case installation/implementation within the health insurance industry.
- Two (2) years group insurance experience.
- One (1) year of experience in underwriting processes, healthcare products and contracts.
- Possess and maintain a high level of knowledge of current / future trends and changes in healthcare/health insurance laws/regulations.
- Knowledge of Kaiser Permanente and the products offered.
Customer Experience Consultant II - Oakland, United States - Kaiser Permanente
Description
: Job Summary:Manage the execution of internal business processes, in one or multiple regions and across multiple cross functional teams, to meet market requirements for quality, accuracy and timeliness in an efficient and effective manner. Serve as the responsible party and central point of contact to collaborate with all internal functional partners to research and resolve internal inquiries or issues and member/customer inquiries or issues.
Essential Responsibilities:
Experience
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Po/Ho Corp - National Acct Regional Team
Pay Range: $ $112530 / hour The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest