United Concordia Companies Inc
Job Description :
This job services United Concordia Dental’s government clients by training and servicing military government officials, members of Congress, military and veteran service organizations, and current/potential plan members in a remote and mobile work environment. It requires development of comprehensive target market strategies for differing contract types that continually fluctuate based on government regulations, shifting populations, corporate objectives, government mandates and contractual modifications. The incumbent is responsible for subsequent implementation of these target market strategies at the local, state, and regional level, requiring continuous monitoring of utilization, enrollment and financial data, and independently adjusting strategies to ensure corporate goals are achieved. The job ensures compliance with contractual requirements through regular on-site military installation and service organization outreach and training. It requires an active role in contract management, training, monitoring and enforcement of company policies and procedures while increasing corporate profitability and scale.
- Strategically identify, target, and develop relationships with military officials and government organizations through fee schedule, military population/beneficiary category, census, and internal profitability report analysis. Develop targeted strategies to advise and educate clients on contract policies and procedures to increase program efficiencies and exceed corporate profitability goals. Continuously monitor financial performance of contracts by tracking utilization, enrollment and competitive environment, including contract specific performance guarantees while incorporating a sound business plan strategy to support the company’s initiatives. Interpret and articulate contractual language to address complex inquiries related to claims, customer service, network, enrollment & billing, and other areas as required.
- Meet and consult with all identified clients in assigned region to collaborate on program quality and performance for multiple government contracts. Formulate customized action plans per client to maintain or improve customer satisfaction with program administration, customer service, online tools and features, etc., to ensure contract retention. Perform effective on-site visits through educating government officials, military dental directors/dental advisers and program administrators on the advantages and benefits of utilizing offered services. Train dental office staff on the use of the information and automated services to ensure proper submission of referrals, claims, and electronic data interchange. Train government officials to run customized reports through comprehensive online reporting system by region, beneficiary category, procedure code, procedure category and readiness classification. Evaluate utilization and enrollment reports by region and implement appropriate courses of action for maximizing profitability by contract.
- Develop strategy and collaborate with Operations and Support areas to ensure the appropriate development and execution of processes, communication needs, and issue resolution. Give professional advice and guidance concerning scope and implementation of policies under the provisions of the corporate and other marketing and education plans. Analyze data from office site visits and review to continually improve the care and service to members and provide recommendations for improvement to the internal customer. Advise the Departments regarding appropriate type and content of dental services to be provided. Recommend changes in scope of benefits, quality, and utilization controls. Recommend new and revised procedures and standards affecting members of dental services.
- Communicate and maintain effective working relationships both internally and externally with public and private agencies engaged in military dental services, keeping management informed on related healthcare industry issues and topics. Support competitive position in the marketplace by staying abreast of changes to the business climate. Act as subject matter expert and assist with formulating strategic and operational recommendations with data supporting input for contract specifications.
- Other duties as assigned or requested
- Bachelor's Degree in Business Administration/Management
- 3 – 5 years experience in Government Relations
- 1 – 3 years experience in Benefits Administration, Billing, Case Management, Business Analysis, Claims, or Government Affairs
- 0 – 1 years of experience in Contract Administration or Data Analytcs
- Analytical Skills
- Benefits Administration
- Public Speaking
- Collaborative Problem Solving
- Presentation Delivery
- Critical Thinking
- Data Analysis
- Government Programs
Language Requirements (other than English)
50% – 75%
PHYSICAL, MENTAL DEMANDS, AND WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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