Delegation Oversight Coordinator

Role Description

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
• Denial ratios
• Quarterly and annual financial accuracy audits

Ability to travel (as business need arises; within assigned territory; less than 10%).

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

Requirements

• 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

Benefits

• Health and wellness benefits
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement
• Other incentives

Company Description

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. Learn more about our benefit offerings by visiting .