Archives: Positions

General Summary:

The Plan Administration Analyst reports to the Plan Administration Manager. This position is responsible for maintaining the provider databases, plan administration support, implementing and auditing contract completion, and vendor management.

• Creates and maintains fee schedule.
• Implements and audits contract completion.
• Vendor Management-We use a vendor to manage repricing contracts electronically.
• Addresses contractual questions, determines nature of inquiry, research information and determines the proper action required.
• Responsible for provider maintenance which maintains and updates all aspects of the provider databases for network providers including credentials, provider network participation, addresses, contracting status and terminations.
• W9 Management.
• Perform other duties as assigned.

General Expectations:

• Present a positive image of Consociate and Dansig at all time.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a client, coworker, or supervisor.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Adhere to established safety standards and utilizes proper techniques to avoid work­ related injuries.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the position’s department.
• Attend required in-service and staff meetings.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.

Service Expectations:

• Greets all people in a prompt and courteous manner. Communicates in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
• Offer and provide assistance whether or not the request falls within your specific job duties.
• Respond to customer requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask.
• Takes appropriate steps to resolve problems to the clients satisfaction.
• Remain aware of products and services provided by Consociate.
• Project a positive, professional image when working.

Knowledge, Skills and Ability Requirements:

• Four (4) years’ experience working in managed care/healthcare environment.
• Healthcare management database experience
• Knowledge of managed care products.
• Knowledge of provider contracting.
• Knowledge of CPT,HCPCS, ICD9, revenue code and/or DRG coding practices.
• Flexibility to meet deadlines in an environment of changing priorities and workloads.
• Effective verbal and written communication skills
• Analytical skills to research and analyze data.
• Ability to work as a team.
• Strong customer service skills.
• Ability to prioritize, organize, and remain focused within established time frames.

Physical and Mental Abilities:

• Ability to perform sedentary work for extended periods of time.
• Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of customers.
• Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.

Reporting Structure/Supervision:

• Reports to the Plan Administration Manger.

Working Conditions:

• Work is performed either onsite or remote.
• Overtime as needed may be requested.
• Travel as needed may be requested.

General Summary:

The Systems Administrator reports directly to the Director of Information Technology. This position provides IT operational support for all servers, storage technology, network infrastructure, etc. Also, this position aids with Tier 1 and Tier 2 user support for incoming service requests and incidents, while helping to ensure that all production systems are fully operational. This position acts as a mentor to junior level team members.

Principal Duties and Responsibilities:

Under the direction of the Director of Information Technology, provide technical support for server and desktop operating systems and hardware platforms as well as troubleshooting for the user community. A broad understanding of different technologies is essential.

Major functions include:

• Implementation and documentation
• Customer service level 1&2 support
• Support of server infrastructure (Windows, Linux)
• Manage DNS, SSL certificates, printing, server hardware, patching, anti-virus, etc.
• Knowledge of Microsoft Networking, Active Directory, AD Group Policies, and Windows Security
• Knowledge of Azure cloud environment
• Responsible for the day-to-day operational support, including after-hours call rotation
• Trouble tickets/ Troubleshooting
• Systems installation, maintenance, and configuration
• Adhering to standard operating procedures within IT Operations, including staff training and documentation.
• Performance monitoring for the health of the infrastructure and applications
• Diverse knowledge across multiple platforms
• Incident management
• Fulfilling service requests
• Patching systems and deploying security remediations
• Ensuring backups are successful

Knowledge and Experience:

• Utilize ITIL best practices around IT Service Management (ITSM) and IT Asset Management (ITAM), including change management
• At least 2-3 years of experience in related work with progression of responsibility
• Scripting and automation using PowerShell, VBS, batch, etc.
• General knowledge of Windows, Linux, and VMware operating systems
• Functional knowledge of Cisco layer 2/3 switches and Palo Alto firewalls
• Experience with Microsoft Azure Cloud Environment configuration and management
• Effective hardware and software problem-solving abilities.
• Ability to manage small projects using project management concepts and tools
• Interpret and/or discuss information with others, which involves terminology or concepts not familiar to many people.
• Associates degree in IT field of study or equivalent work experience
• Industry standard certifications are encouraged

Skills:

• Must be a self-starter and be able to work well independently or in a team
• Ability to skillfully react to a fluid and constantly changing work environment.
• Solid troubleshooting skills and demonstrated ability of end-to-end problem management and ownership
• Ability to prioritize and organize work assignments
• Communication skills to talk with others to convey information effectively while providing best in class customer support
• Able to prepare high-level project plans, presentations, procedures, diagrams, and other technical documentation
• Effective Time Management
• Open to continuous learning
• Participate in the weekly rotational after-hours on-call support

Physical and Mental Abilities:

• Ability to perform sedentary work for extended periods of time.
• Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of customers.
• Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.

Working Conditions:

• Work is performed in a normal office environment.
• Overtime as needed may be requested.
• Travel as needed may be requested.

General Summary:

The Plan Administration Manager reports to the Chief Administrative Officer. This role is very collaborative and will require in-depth knowledge of the benefits department workflow and how this impacts other departments. This position oversees the day-to-day operations of Plan Administration, and is responsible for the following duties of these departments:

Principal Duties and Responsibilities:

• Benefit Plan Analysts (5)-assure that all benefit plans are programmed accurately and timely within the claims system.
• Plan Administration/Provider Maintenance Analysts (2), – assure that all provider databases are maintained with demographic information, fee schedules, and network. participation. Internal and external provider inquiry resolution.
• Utilization Management Coordinator (1), -Claims appeals are reviewed and responded to in accordance with regulatory guidelines. This position would oversee the Utilization Management process, and assist where necessary.
• Auditor (1)- Oversee the auditing program of claims payments to ensure processing was in accordance with established procedures, plan design, vendor requirements, contract terms and Regulatory guidelines.
• Manage employee development and performance.
• Coordinate and/or assist with special projects at the direction of the CAO.
• Perform other duties as assigned.

General Expectations:

• Present a positive image of Consociate at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a client or coworker.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Plan Administration Division.
• Attend required in-service and staff meetings.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups, individuals and employees.
• Adheres to established safety standards and utilizes proper techniques to avoid work-related injuries.

Service Expectations

• Greet all people in a prompt and courteous manner. Communicate in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
• Offer and provide assistance whether the request falls within your specific job duties.
• Respond to clients and coworkers requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask.
• Make decisions based on client needs, opinions, or suggestions.
• Take appropriate steps to resolve problems to the client’s satisfaction..
• Seek opportunities, provide value-added services, and eliminate tasks that do not serve our client.
• Remain aware of products and services provided by Consociate Dansig.
• Project a positive, professional image when working.

Knowledge, Skills and Ability Requirements:

• Bachelor’s degree in health, business or related field or comparable work experience.
• Three (3+) Years of Management Experience.
• Ability to analyze benefit plans and programming rules to demonstrate a benefit structure within an automated claims processing system.
• Four (4) years’ experience working in a managed care/healthcare environment.
• Healthcare management database experience.
• Knowledge of managed care products.
• Knowledge of provider contracting.
• Knowledge of CPT, HCPCS, ICD9, revenue code and/or DRG coding practices.
• Strong analytical, technical, and problem-solving skills.
• Mini Project Management Skills
• Ability to maintain production levels and quality goals.
• Must be articulate, possess professional business manner and have excellent organizational, interpersonal and communication skills.
• Ability to understand the systems functionality and business policies.

Physical and Mental Abilities:

• Ability to perform sedentary work for extended periods of time.
• Ability to utilize personal computer, telephone system, and communicate with a variety of clients.

Reporting Structure/Supervision:

• Reports to the Chief Administration Officer.

Working Conditions:

• Work may be performed onsite or offsite.
• Overtime as needed may be requested.
• Travel as needed may be requested.

General Summary:

The Director of Stop Loss reports directly to the Chief Growth Officer.
This position will work closely with the Chief Growth Officer, Chief Financial Officer, Account Executives, and Underwriters on renewal and new business stop loss strategies to successfully meet our clients’ goals and financial objectives. The Director of Stop Loss will serve as the key resource and liaison between stop loss carriers and consultants/brokers, as it relates to stop loss contracting, claims, marketing and performance. He/She will oversee and manage the stop loss department operations to assure that standards of excellence are met and tracked with actionable reporting and appropriate testing and auditing. They will Provide supervision, development and support to the entire Stop Loss Department, to assure compliance with regulatory and policy requirements and service level standards.

Principal Duties and Responsibilities:

• Assisitng the Chief Growth Officer with the selection of stop loss markets which meet the needs of the wide range of their clients
• Coordination of the TPA approval process with stop loss markets.
• Development and oversight of best practices related to the marketing of stop loss, including new technology vendors, sales role in data gathering, preparation of marketing packets for the stop loss markets, analysis of proposals, preparation of recommendations and negotiations.
• Coordination of all post sale underwriting processes, including final underwriting and contract review.
• Active participation in the underwriting and marketing of stop loss for prospects and existing clients.
• Manage continuous quality improvement in Consociate Health’s marketing efforts, including measurement of metrics on the marketing process, (timeliness, close ration, distribution among markets, etc.) and implementation of strategies and systems to enchance those metrics.
• Provide training and coaching to the Consociate Health Stop Loss Team as required.
• Other possible duties as may be assigned.

General Expectations:

• Present a positive image of Consociate Health at all time.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a Client, co-worker.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with all team members.
• Attend required in-service and staff meetings.
• Seek other educational opportunities directly related to this position.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
• Adheres to established safety standards and utilizes proper techniques to avoid work-related injuries.

Service Expectations

• Ask Clients what they need and strive to exceed their expectations. Offer and provide assistance whether or not the request falls within your specific job duties.
• Respond to Client requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask.
• Make decisions based on Client needs, opinions, complaints or suggestions.
• Take appropriate steps to resolve problems to the Client’s satisfaction.
• Ask Clients for their opinions, accepting criticism as an opportunity to improve service.
• Seek opportunities, provide value-added services, and eliminate tasks that do not serve our Client.
• Remain aware of products and services provided by Consociate Health.
• Project a positive, professional image when working.

Knowledge, Skills and Ability Requirements:

• Bachelor degree in health, business or related field or comparable work experience.
• Ability to understand, discuss and/or present stop loss contract variations.
• Ability to build and maintain a professional working relationship with stop loss markets, brokers and consultants.
• Strong management/leadership skills.
• Excellent organizational and time management skills.
• Understanding of the Insurance Industry, marketing and sales.
• Excellent verbal and written communication skills.

Physical and Mental Abilities:

• Ability to perform sedentary work for extended periods of time.
• Ability to utilize personal computer, telephone system, and communicate with a variety of Clients.
• Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.

Reporting Structure/Supervision:

• Reports to the Chief Growth Officer.

Working Conditions:

• Position may be performed offsite with some time spent onsite in the Corporate Office as needed.

General Summary:

The Account Executive reports to the Director of Client Relations. This position will lead clients as a strategic consultant and will serve as the key interface between Consociate Health, and new and existing clients and brokers in relationship to the management and administration of client accounts.

Principal Duties and Responsibilities:

• The Account Executive will drive strategy alignment and serve as the face of Consociate Health in relationship to daily interaction with their client base.
• Develop and execute service strategies tailored to client needs.
• Track and trend issues to determine common issues that require process improvement.
• Responsible for quality assurance and assisting all departments with seamless customer support.
• Create and maintain an annual timeline of services per each client group.
• Resolve Client issues.
• Conduct Employer Meetings, (review health plan reports, conduct enrollment meetings, explain internal procedures and new product offerings).
• Manage Broker relationships.
• Oversee implementation of new groups.
• Present renewals.
• Review Contract Specifications.
• Review TPA Agreements.
• Review monthly reporting
• Set up and account management of client specific Pharmacy Benefit Manager, (PBM).
• Review and distribute SPD’s, SBC’s and Plan Amendments to appropriate departments.
• Coordination and creation of client/broker requested reports.
• Responsible for providing reporting and information to clients upon request or at scheduled quarterly/annual meetings.
• Other possible duties as may be assigned.

General Expectations:

• Present a positive image of Consociate Health at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer or a coworker.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the Client Relations Division.
• Attend required in-service and staff meetings.
• Seek other educational opportunities directly related to this position.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
• Adheres to established safety standards and utilizes proper techniques to avoid work-related injuries.

Knowledge, Skills and Ability Requirements:

• Bachelor degree in health, business or related field or comparable work experience.
• Understanding of the Insurance Industry, marketing and sales.
• Licensing in Life, Health and Accident.
• Excellent human relations skills.
• Must be articulate, possess a professional business manner and have excellent organizational and communication skills.
• Strong ability to identify appropriate resources for research and problem resolution.

Physical and Mental Abilities:

• Ability to perform sedentary work for extended periods of time.
• Ability to utilize personal computer, telephone system, and communicate with a variety of customers.
• Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.

Reporting Structure/Supervision:

• Reports to the Director of Client Relations

Working Conditions:

• Position may be performed offsite with some time spent onsite in the Corporate Office as needed.
• Travel to customer locations for meetings as needed, approximately 40% travel required during 4th quarter each year.