Health Plans, Inc.

Accounting Manager

• Responsible for accounts receivable, abandoned property reporting, bank account reconciliations
• Process invoices, check deposits, and wire payments
• Process manual and auto surcharges and post payments
• Return check batch completion
• Perform check tracers
• Consolidate/research outstanding checks, send letters and coordinate voids and/or void and reissue checks when necessary

Accounting Coordinator

QA Engineer

• Conduct internal audits of high-dollar claims and adjustment transactions, including audits exceeding $50,000 to $100,000+.
• Partner with external audit vendors to address questions, provide feedback, and ensure audit accuracy.
• Process claim adjustments, refunds, recoveries, voids, reissues, and Medicare demand transactions.
• Analyze adjustment and refund activity to identify trends, determine root causes, and recommend process, training, or system improvements.
• Investigate potential operational or payment issues and provide recommendations to management.
• Collaborate with provider billing vendors to request refunds, process claim adjustments, and review audit-related correspondence.
• Monitor and track adjustment activity, maintaining accurate documentation and reporting.
• Prepare and present monthly department audit results and key findings.
• Support continuous improvement initiatives by identifying opportunities to enhance accuracy, efficiency, and compliance within claims and audit processes.

Quality Assurance Examiner

Human Resources

• Provide support in the day-to-day operations of the Human Resources department
• Participate in the development and implementation of company onboarding procedures
• Assist in various aspects of Human Resources administration, including ensuring new hires have an exceptional onboarding experience
• Prepare and maintain employee files, and process necessary changes within the HRIS
• Collaborate with the Manager of Human Resources on various departmental projects
• Manage the HR inbox, ensuring timely, professional, and accurate responses to employee and manager inquiries
• Coordinate and oversee the new hire onboarding process
• Maintain a comprehensive understanding of employee benefit programs, wellness initiatives, and other employee offerings
• Process employee transactions within HRIS
• Communicate new hire information and employee payroll changes to relevant parties
• Maintain payroll tracking spreadsheets and generate reports
• Serve as an HRIS (ADP) administrator
• Conduct audits of payroll, benefits, and other Human Resources programs
• Prepare and process offboarding documentation for departing employees
• Keep the Manager of Human Resources informed of departmental activities, issues, and process updates
• Identify and implement opportunities for continuous process improvement
• Maintain accurate and confidential employee records

HR Operations Analyst – Coordinator

Billing Specialist

• Supervise, mentor, and train billing team members.
• Foster a collaborative and positive work environment.
• Assign tasks and monitor performance to ensure targets are met.
• Oversee daily billing activities, including billing coordination, billing, and reconciliation.
• Ensure timely and accurate submission of invoices to clients.
• Review and resolve billing discrepancies or errors.
• Maintain up-to-date knowledge of industry regulations and payer requirements.
• Ensure billing practices comply with HIPAA and other relevant standards.
• Conduct regular audits to identify and correct issues.
• Address escalated billing inquiries from clients.
• Provide clear explanations of billing procedures and resolve concerns promptly.
• Identify opportunities to streamline billing workflows.
• Implement best practices and new technologies to enhance efficiency.
• Generate and analyze billing reports to track performance metrics.
• Present findings and recommendations to management.
• Monitor key indicators such as billing accuracy and invoice punctuality.
• Lead prior experience in leading the Billing department in software migrations.
• Ability to successfully lead the migration of the Medcost clients from the PowerStepp system to the Javelina system.

Billing Manager

Accountant

• Assist Director of Finance in reconciling and preparing supporting schedules for month end close
• AR Reconciliations
• Monthly Bank Reconciliations
• Monthly Reconciliation of various general ledger accounts
• Cross training on critical duties to provide back up for Director of Finance when needed
• Assist Director of Finance with budgeting and forecasting
• Assist Director of Finance with preparing financial information requests
• Update and develop various schedules as necessary during year-end auditing period
• Assist Director of Finance with accounting related functions as they arise and as necessary

Junior Staff Accountant

Compliance

• Review incoming compliance inquiries and requests, and assist with routing and handling as directed by the Assistant General Counsel
• Establish and identify key players within the company for compliance and legal process initiatives
• Coordinate compliance and legal process initiatives by tracking progress, scheduling meetings, and facilitating interdepartmental and intradepartmental communication with key players
• Keep internal stakeholders informed regarding deadlines, turnaround targets, and status updates
• Assist in managing the contract management system for the Compliance department
• Provide additional coordination for other Compliance related tasks as requested, including certain licensure and regulatory filings
• Coordinate the integration of company affiliate compliance related policies and procedures, as well as with the creation of new policies and procedures as directed by the Assistant General Counsel.

Compliance Coordinator

• Serve as a subject matter expert and strategic partner responsible for the end-to-end development, drafting, and management of client Administrative Services Agreements (ASAs) and related contract documents.
• Exercise a high degree of independent judgment in ensuring that ASAs and related contract documents are issued in a timely and accurate fashion.
• Collaborate closely with Compliance leadership and cross-functional partners to deliver high-quality, compliant, and scalable contract solutions.
• Lead the end-to-end lifecycle of client contracts, including drafting, revision, execution, and ongoing management of ASAs.
• Establish and maintain contract governance standards, ensuring consistency, compliance, and alignment with organizational objectives.
• Mentor and provide guidance to less experienced team members.
• Identify opportunities to improve operational efficiency, reduce cycle times, and strengthen compliance controls.
• Provide guidance and consultative support to internal stakeholders on contract terms.
• Partner with Client Services, Sales, Compliance, and other departments to resolve contract-related issues and ensure alignment on client deliverables.
• Oversee tracking and reporting of ASA contract status, ensuring timely distribution of ASA contracts to internal stakeholders.

Senior Compliance Contract Specialist

Account Manager

• The Account Manager (AM) is responsible for coordinating and managing the plan implementation for new clients, as well as managing the overall servicing of account issues for existing clients.
• Coordinate the implementation of new groups and overall servicing of account issues for existing clients and brokers.
• Conduct benefit meetings, producing educational materials, resolving claims/service issues.
• Communicate with internal staff on any plan design changes, renewal changes, or other relevant information to ensure the plan runs smoothly for each client.
• Develop all employee/employer materials.
• Prepare reports requested by employers/brokers.
• Assist clients/brokers with analysis of reports.
• Notify and assist clients/brokers with compliance and reporting requirements with respect to benefit plans federal mandates etc.

Account Executive

• Serve as the primary contact for group representatives and brokers, ensuring smooth plan implementation, ongoing service and renewals.
• Produce educational materials, conduct benefit meetings, and design the plan.
• Work strategically with the consulting team and client to help manage and evolve the health plan.
• Provide renewal consultation, plan design advice and execute internally any plan design or renewal changes.
• Prepare plan performance reports and assist with analysis.
• Offer new programs/services as appropriate.
• Notify and assist clients/brokers with compliance and reporting requirements.

Client Services Representative

• The Account Coordinator is responsible for assisting the Vice President of Client Services, Account Manager and Client Service Representative with the plan implementation for new clients.
• Assisting with the handling of the overall servicing of account issues for existing clients.
• For new clients, the Account Coordinator will assist the Account Manager and Client Service Representative in the coordination of the plan implementation by producing and compiling educational materials.
• The Account Coordinator works closely with internal staff to communicate service issues and resolve claim payment issues.
• Serves as the in-house client contact when the Account Manager and Client Service Representative are unavailable.
• Assist with the coordination of implementing new groups and overall servicing of account issues for existing clients and brokers.
• Produce educational materials and help resolve claims/service issues.
• Provide administrative support to the Client Services department.
• Notify internal staff of any plan design changes, renewal changes, or other relevant information to ensure the plan runs smoothly for each client.

Account Coordinator, Client Services

Claims Specialist

• Process claims in accordance with plan benefits
• Maintain quality average of 98%
• Handle correspondence from Plan Correspondent and/or employees in a timely and efficient manner
• Work with staff on filings for claim benefits investigation (pre-existing condition, medical necessity reviews, etc.)
• Provides assistance to examiners to ensure accurate timely claims processing
• Perform other various tasks that are deemed necessary and equitable by the claims supervisor
• Special projects as determined by area management

Senior Claims Examiner

Implementation Specialist

• Lead the client onboarding process by understanding their unique needs, objectives, and expectations.
• Participate in onboarding kick off meeting with new clients to gather and document client requirements and vendors related to their self-insurance plan(s) claims processing, eligibility criteria, and other relevant aspects.
• Develop a comprehensive implementation plan outlining key milestones, timelines, and responsibilities.
• Act as a liaison between clients, internal teams (such as account management, compliance, plan build, claims, and finance), and external vendors to facilitate effective communication and collaboration.
• Coordinate meetings, conference calls, and training sessions to ensure alignment and understanding of implementation objectives and processes.
• Prepare comprehensive documentation, including implementation guides, process workflows, and training materials, to support clients and internal stakeholders.
• Assist Client Services with training sessions for clients and end-users on the use of self-insurance administration systems, policies, and procedures.
• Execute implementation plans that are on time and with high customer satisfaction.
• Update and collaborate project plan details for downstream workflows to produce accurate configuration and set up ensuring any late changes are identified and addressed appropriately.
• Proactively identify potential issues or challenges in the implementation phase escalating critical issues as needed.
• Represent Health Plans Inc. to clients and vice versa, serving as a trusted advisor and advocate, ensuring a high level of service and satisfaction.
• Provide weekly updates to client, broker/consultant, internal teams as to implementation status by tracking progress and identify and manage risks, driving initiatives to enhance client satisfaction and retention.
• Address any discrepancies or issues promptly and implement corrective actions as needed to ensure accuracy and client satisfaction.
• Complete transition to Client Services team within 60 days of implementation.
• Work with Implementation Team to identify opportunities for evaluation, process improvements, and enhancements to streamline the implementation process and enhance overall efficiency.
• Stay informed about industry trends, regulatory changes, and best practices related to self-insurance administration and incorporate relevant updates into our implementation processes.

Client Implementation Specialist

• Process vendor claims in accordance with plan benefits.
• Maintain minimum quality and production levels as determined by the Claims Supervisor.
• Maintain reconciliations as required by the vendor.
• Assist the Vendor Management team with status or claim review.
• Handle correspondence in a timely and efficient manner.
• Resolve claim issues that do not require outside involvement.
• Perform other various tasks that are deemed necessary and equitable by the Claims Supervisor

Vendor Claims Examiner

• Adjust/Process claims in accordance with plan benefits
• Maintain quality average of 98%
• Handle adjustment requests in a timely and efficient manner
• Special projects as determined by area management
• Provides assistance to examiners to ensure accurate timely claims processing of adjustments
• Perform other various tasks that are deemed necessary and equitable by the claims supervisors.

Claims Adjuster

• Process claims in accordance with plan benefits.
• Maintain minimum quality and production levels as determined by the Claims Manager.
• Maintain updated filings for claim benefit investigation (medical necessity reviews, etc.) as required in accordance with plan benefits.
• Prepare filings for outside vendors (subrogation) as required in accordance with the plan benefits.
• Handle correspondence from Plan Correspondent and/or employees in a timely and efficient manner.
• Resolve claim issues that do not require outside involvement.
• Serve as back-up to Customer Service department, as needed.
• Perform other various tasks that are deemed necessary and equitable by the Claims Manager