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.

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

Compensation: $55,900.00 - $123,500.00

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

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards