Health Plan Director

Under the direction of the Assistant Vice President, Health Plans, oversees the implementation of new Managed Care Organization (MCO) clients and continuing administration vision benefits for current clients. Effectively builds relationships with clients in order to retain, renew, and grow our business. Acts as primary liaison to between internal departments and clients to communicate requirements and capabilities. Translates client requests for internal use. Asks appropriate questions and follows up as necessary to determine needs and communicate capabilities. Oversees business and technical analysis related to health plans support, which consists of identifying health plan needs and determining solutions to problems, audit support, claims processing and State and Federal reporting. Packages internal reporting for presentation to clients and regulatory authorities.

Desired Competencies

• Balanced Confidence: Demonstrates the ability to make informed decisions with conviction while remaining open to feedback, new ideas, and continuous learning.
• Accountability: Accepts responsibility for outcomes, acknowledges mistakes, and demonstrates commitment to improvement.
• Collaboration: Builds trust, fosters teamwork, and maintains strong, professional relationships with clients and colleagues.
• Continuous Improvement: Embraces innovation, adapts to changing circumstances, and drives process enhancements to achieve organizational goals.

Essential Duties & Responsibilities

• Manage communications between internal departments and clients to ensure clear understanding of requirements and organizational capabilities.
• Partner with the Chief Compliance Officer to stay current on governing regulations and ensure appropriate communication and response to regulatory changes.
• Lead implementation processes in collaboration with the Director, Project Management, developing and adjusting implementation plans across multiple lines of business.
• Oversee resolution of implementation and operational issues between clients and internal departments.
• Identify trends or issues that may affect client satisfaction through data analysis of claims, grievances, appeals, and coverage determinations, and develop appropriate solutions.
• Collaborate with Claims and Finance departments to design and maintain systems that ensure accuracy of claim adjudication and invoicing.
• Establish and maintain quality control processes for client reports, including those submitted to regulatory authorities.
• Provide direct client support during regulatory audits.
• Prepare and deliver accurate, comprehensive, and timely reports to clients, ensuring actionable insights are communicated effectively.
• Represent the Vice President in designated meetings.
• Perform other related duties as assigned.

Qualifications Requirements

• Minimum of seven years’ experience in managed care or healthcare insurance in a member or client relationship role, with at least five years’ experience with Medicare, Medicaid, and Federal Exchanges.
• Minimum of two years’ experience in performance improvement or project management preferred.
• Strong problem-solving, organizational, analytical, and communication skills (oral and written).
• Proven ability to interact effectively at all levels within the organization.
• Demonstrated capability to manage multiple projects simultaneously, ensuring objectives and timelines are achieved.
• Bachelor’s or Master’s degree in Health Administration, Business Administration, or a related field preferred.
• Proficiency in Microsoft Excel, Word, and PowerPoint required; proficiency in Outlook and SharePoint preferred.

Featured Benefits

• Competitive salary
• Vacation and Sick/Personal Time
• Medical Insurance
• Hearing Program Discount
• Short- & Long-Term Disability Insurance
• Life Insurance
• Flexible Spending Account
• 401(k)
• Employee Referral Program
• Employee Recognition
• Tuition Reimbursement
• Professional Development Training

About Benecard Services our affiliated companies:

Benecard Services, LLC

Benecard Services, LLC has been administering carve-out, fixed rate insured prescription drug benefit programs since 1990. Benecard is a full service, in-house prescription benefit administrator that includes mail and specialty drug dispensing. We are a premiere nationwide Prescription Benefit Administrator headquartered in Lawrenceville, New Jersey.

Website: http://www.benecard.com

BeneCard PBF

BeneCard PBF provides self-funded prescription benefit program administration with a personalized approach through focused, clinical expertise. Our business model operates on a customized claim processing system offering unlimited capability and flexibility to respond to client needs in an evolving marketplace. Advanced clinical programs and advanced technology provide the framework to maximize the use of all data elements available. This allows BeneCard PBF to filter the information, focus on clinical opportunities and facilitate interaction between the physician, the pharmacist and the patient to effectively promote complete health care. Headquartered in Bonita Springs, Florida.

Website: http://benecardpbf.com

National Vision Administrators

For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health & Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.

Website: http://www.e-nva.com

We are an Equal Opportunity employer.