Health Plans, Inc.

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

Claims Examiner

Account Manager

• Responsible for assisting with the coordination of the implementation of new groups and overall servicing of account issues for existing clients and brokers.
• Responsible for producing educational materials, resolving claims/service issues.
• Responsible for providing administrative support to the Client Services department.
• Responsible for assisting with the communication with internal staff on any plan design changes, renewal changes, or other relevant information to ensure the plan runs smoothly for each client.
• Supervising and training the Account Coordinator team
• Assigning projects to the Account Coordinator team
• Working with the Director of Client Services and Vice President of Client Services to report escalations
• Identifying areas of opportunity and areas of concern with the team
• Tracking PTO for the team and maintaining a PTO tracker
• Coordinating with the Vice President and Director to approve PTO for all Client Services staff, including Account Executives (AEs), Account Managers (AMs), and Account Coordinators (ACs)

Team Lead, Account Coordinator

Analyst

• Conduct regular audits of financial transactions related to claims funding, billing, and stop loss submissions processed by the teams to ensure adherence to industry regulations and internal policies & procedures
• Review and analyze reports to identify discrepancies, errors, or trends that may impact financial performance
• Support all external audit requests and audit of materials gathered prior to submission
• Maintain accurate and organized records of all quality control activities, including audit results, corrective actions taken, and follow-up measures
• Act as a subject matter expert for projects aimed at process improvement and operational excellence
• Recommend process changes based on audit findings and industry standards to improve overall service delivery
• Prepare detailed reports summarizing findings and presenting them in a clear and actionable format to management
• Participate in cross-functional meetings to discuss quality issues and propose solutions
• Accountable for reaching target metrics related to quality & performance improvements
• Assist in the development of departmental policies and procedures
• Provide training and support to staff on quality control processes and compliance requirements
• Assist with researching and resolution of client issues
• Assess the need for a sense of urgency with all work activities and communicate appropriately with department leadership to coordinate response/resolution.