Meridian

  • Manager of Benefit Configuration

    Job Location US-MI-Detroit
    Job ID
    2018-5763
    Category
    Operations
    Business Line
    CMC Corporate
  • Overview

    Who we are:

    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.


    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.


    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

     

    A Day in the Life of a Manager of Benefit Configuration:

    This position works under the direction of the division of Corporate Operations and the Senior Vice President of Corporate Operations. This position provides assistance with appropriate representation of benefits, build and configure benefits, as well as develop the team.  They provide operational support to, and analysis of, all Benefit Configuration-related activities, as well as the Benefit Configuration team. This position and team creates, updates, tests and maintains system configuration to support all benefit designs and ensure successful configuration and integration, as well as builds, updates, tests and maintains the comprehensive benefit tool used for the entire enterprise.

    Responsibilities

    • Under the direction of the  Sr. VP of Corporate Operations work collaboratively with each department director/manager to develop and maintain appropriate interface specific to business needs across the organization
    • Work collaboratively with business owners to best support needs for benefit determinations
    • Participate in or liaison with relevant plan committees and represent Benefit Configuration in meetings.
    • Responsible for the Benefit Configuration Team, their work performance, project outcomes and development
    • Assist in translating benefits and details into system configuration parameters
    • Ensure compliance with the health plan policies for complete, accurate and consistent benefit plan design, resulting in appropriate benefit administration and data integrity
    • Review and revise business and plan design requirements for system set-ups and configurations
    • Assist in communicating issues and opportunities for improvement regarding system enhancements
    • Work collaboratively with teams to ensure appropriate benefits and payment are set up, tested and operationalized
    • Lead business requirements development and solution design process upon implementation of new clients and/or products
    • Develop new (and review/update existing) Policies & Procedures (P&P’s) in support of standardized and accurate benefit configuration
    • Maintain up-to-date knowledge of regulatory changes impacting benefit administration (e.g. ICD-10, ASC, DRG, CPT, HCPCS etc.)
    • Assist in creating and maintaining provider, member and staff materials that reflect appropriate benefits for all programs
    • Educate CMC employees on company policies and procedures regarding benefit plan designs
    • Remain updated on all member and provider policy changes made by the health plan, CMS and/or the State
    • Compile information and prepare reports and analyses of results of benefit configuration findings including appropriate recommendations
    • Assist all internal and external stakeholders with reports as requested
    • Provide assistance in the preparation of materials and documentation pertaining benefit configuration
    • Conduct research, assessment and analysis for projects or reports, as needed
    • Supervise and train subordinate employees
    • Maintain strict confidentiality of employee and organizational information

    Qualifications

    What you can bring to Meridian:

    • Bachelor’s degree, fellow Designation from the Academy of Healthcare Management (AHM), or equivalent experience is required
    • Customer service experience or related health care industry experience is preferred.
    • Demonstrated adaptability and flexibility to changes and response to new ideas and approaches is required.
    • Knowledge of managed care, Medicaid, Medicare and HIX programs are required.
    • Knowledge of the health plan programs, benefits, and services for all lines of business for our members.
    • Knowledge of National Committee for Quality Assurance (NCQA), URAC or general accreditation standards
    • Knowledge of appeal and grievance guidelines is preferred.
    • Knowledge of Network configuration and impacts is preferred.
    • Knowledge of Prior Authorization configuration is preferred.
    • Superior analytical and problem solving skills.

     

    What Meridian can offer you:

    • Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • Meridian offers 401k matching that is above the national average.
    • Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
    • Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.


    Equal Opportunity Employer

     

    #MSTR

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Connect With Us!

    Not ready to apply? Connect with us for general consideration.