Provider Network Report Analyst (3 Positions)
As a Provider Network Analyst, you will support the agency’s mission by performing analytical reviews and evaluations of healthcare provider networks. You will analyze data, develop data models, and use business analytical tools to produce data visualizations. You will develop reports to make recommendations for management consideration regarding issues of potential healthcare provider network access gaps identified through internal referrals, healthcare providers, and consumer complaints.
Reporting to a Functional Program Analyst 4, these positions are responsible for performing the following duties to include, but not limited to:
Compiling, organizing, analyzing, and interpreting healthcare data provided by multiple sources. Examines both qualitative and quantitative data to find patterns and trends.
Reviews network access reports to create trend analyses and summaries for decision-making purposes. Assimilate large quantities of simple and moderate data into meaningful formats for tracking and status inquires.
Communicates with insurance companies, attorneys, consumers, and OIC staff regarding network access reports, market availability, laws, and regulations.
Develops reports utilizing insurance company’s data to assist management in making determinations about network compliance with state and federal law.
Performs research and analysis for low-impact (simple) network access proposals related to consumer inquiries and referrals from Consumer Advocacy and Market Conduct units.
Provides analysis and interpretation of technical healthcare data filed within federal binder templates required by the Affordable Care Act certification process to participate on the Health Benefit Exchange.
Bachelor’s degree in Public Administration, Business Administration, Social Sciences, or a closely related field from an accredited institution whose accreditation is recognized by the U.S. Department of Education or the Council of Higher Education Accreditation or a foreign equivalent.
(Additional relevant professional experience working in the healthcare, insurance or regulatory field interpreting, analyzing or reporting on statutory requirements will substitute year for year for education.)
Two years of professional work experience in one or more of the following:
Ensuring compliance with governmental statutory and regulatory requirements; or
Professional work with Health & Disability insurance, Self-funded plan, or Provider Relations; or
Experience related to healthcare claims payment configuration, credentialing, or utilization process/systems and the relevance on network operations impact; or
Experience analyzing both qualitative and quantitative data. Using business intelligence software and creating data visualization reports to aid in analysis and to present findings for a variety of audiences.
Intermediate level Microsoft Office Outlook with the ability to set calendar options; sort, find and filter messages; customize message options; use the journal entry to track and record; assign, reply and track tasks; create public folders and send and post information.
Intermediate level Microsoft Office Word with the ability to create, save, preview and print documents; edit text, format documents; and use auto-correct.
Intermediate level Microsoft Excel skills with the ability to use formulas (including VLOOKUP, COUNTIF, AND/OR) , perform conditional formatting, apply data list outline, consolidate data and link workbooks, export and import text files and XML data; import data from the Web and create Web queries, analyze data using trend lines.
Experience drafting, analyzing, researching, or applying the requirements of provider and facility contracting.
Intermediate skills in Microsoft Power BI with the ability to create reports, extract data, design and edit reports.
Previous healthcare analytics experience directly assisting in preparation of monthly, quarterly, and annual data reports for state or federal reporting for assuring compliance with healthcare statutory requirements such as Title X, Medicaid, or Medicare.
Working toward or have an industry specific designation such as Certified Health Data Analyst (CHDA), Registered Health Information Technician (RHIT).
Annual Salary: $4656.00 – $6105.00
Seeking external hire with commercial auto insurance experience. Skills in the following areas are of particular interest: Underwriting, marketing, sales, distribution, vendor management, billing, customer service and/or compliance.
Annual Salary: https://corporate.ford.com/content/dam/corporate/us/en-us/documents/careers/2022-benefits-and-comp-GSR-sal-plan-1.pdf
Annual Salary: $65,000 – $85,000
The Account Management team is a tight-knit group responsible for enrolling, renewing, and ongoing service for group benefit coverage. These professionals provide administrative services to make necessary group plan changes and provide ongoing support to the groups and agents/brokers. Our Account Managers are essential partners to our Client’s HR Directors as well as our agents/brokers in providing basic knowledge of group benefits.
Headquartered in Salt Lake City, UT, MGIS is a leading national insurance program manager experienced in building and managing specialized insurance programs for healthcare professionals. We partner with highly rated insurers and focus on disability and life insurance for practices of all sizes, types, and medical specialties. Insurance policies managed by MGIS are backed by members of the Sun Life group and Certain Underwriters at Lloyd’s. We work exclusively through select brokers and insurance advisers. MGIS has been named one of the Best Places to Work in Insurance for 10 years by Business Insurance Magazine and Best Companies Group.
• Enter and update member, group, and coverage information, group benefit summary (GBS), riders, endorsements, administration manual, certificates and booklets to be delivered to the group or member. Process requests and follow-up on decisions. Make group billing changes: manual adjustments; terminations, salary adjustments, correcting errors, billing contact: address changes; sabbatical requests; absolute assignments; riders, anniversary change, name change, set up new billing locations and codes on existing business; download census; check payments.
• Extensive interaction with brokers and representatives.
• Communicate any carrier matter or notifications to the group and agent.
• Provide ongoing customer service to groups and agents and facilitate with the carrier(s).
• Review and submit claims to carrier, update administration system of claim decision and premium waivers.
• Create and maintain data files based on producers, requests, and follow-up; and file enrollment cards and all correspondence.
• Assist in training new employees
• Work cohesively with others
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. This position requires extensive interaction with brokers/agents and coordination with various departments within the company. Experience in working with benefits brokers/agents/producers preferred. High School Diploma is mandatory.
EDUCATION and/or EXPERIENCE
An Associate degree with two years of related experience; or an equivalent combination of education and experience is required. Preference will be given to individuals with a current life and health license.
Must have EXCELLENT communication and professional skills to effectively address and service producer requests. Must be able to multi-task and function effectively in a high paced, demanding atmosphere. To perform this job successfully, an individual should have knowledge of Microsoft Word and Excel.
Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Apply Here: https://www.click2apply.net/kLLPOxTD61ownIqMnT4MN5
Associate Director, Insurance Products State Filing
The Associate Director, Insurance Product/State Filing, is a member of the Company’s Law and Compliance Department. The position works with other internal departments and external third-party vendors, as needed, to establish and implement the company’s insurance products.
This position is responsible for developing compliant insurance product materials, filing them with insurance regulators, and obtaining necessary approvals. Working with the Director, Insurance Product/State Filing, the Associate Director will manage the Company’s portfolio of insurance product forms and monitor compliance with applicable state and federal laws.
This position will work with limited supervision and be responsible for making an established range of decisions, escalating issues across internal business areas as necessary or appropriate, and updating management on a regular basis. As a member of the Law and Compliance Department, this position will also be integrated into the group’s work on federal securities filings and other matters as assigned.
Maintaining and applying a comprehensive understanding of compliance requirements regarding insurance product features, filing requirements, state variations, form requirements, marketing strategy and target markets for specific insurance products.
Communicating directly with internal business areas to provide timely input on product design matters by analyzing new product details, identifying relevant state requirements, highlighting potential regulatory compliance issues, recommending possible solutions, and working collaboratively to implement them.
Drafting product forms and assisting with prospectus drafting for variable products.
Developing strategy for form filing projects and optimizing approvals within desired timeframes.
Making state filings via the NAIC’s System for Electronic Rate and Forms Filing (“SERFF”), interacting with state regulatory agencies, internal departments and third party filing agents as needed to respond to objections, and managing filings through to approval.
Designing processes for maintaining timely and accurate records relating to state filing and compliance.
Communicating state filing approvals and implementation requirements to internal departments.
Participating actively in internal discussions about operational implementation of the Company’s products, identifying implementation issues that may affect filed forms, and taking responsibility for any filings needed or requested to adjust previously approved forms.
Keeping current with industry and regulatory trends related to product filings.
Bachelor’s degree preferred.
8+ years of state filing, insurance regulatory and/or paralegal experience preferred.
Detail-oriented and capable of managing multiple projects and initiatives at one time.
Demonstrated ability to receive, organize and manage large amounts of diverse information and documentation to meet deadlines.
Strong analytical and research skills, including experience identifying, defining and resolving problems.
Strong verbal and written communications skills with demonstrated ability to interpret and communicate business needs and solutions clearly between internal and external constituencies.
Demonstrated ability to work effectively both independently and collaboratively within a team environment.
Knowledge of the life insurance industry, including product types and basic regulatory framework.
Health Forms Manager
This position is a member of the Rates, Forms and Provider Networks management team. Reporting to the Forms Compliance Manager, the Health Forms Manager is responsible for the timely, consistent, and efficient review of health plan form filings submitted by the insurance industry. This includes ensuring that state and federal statutes, rules, and case law are accurately reflected in the processes, procedures, and review criteria produced by professional staff for use on reviewing health plan forms and depended upon by Insurance companies when developing health plans and submitting form filings for use in Washington State. This position focuses on the implementation of the Affordable Care Act.
Develops short-term strategic (1-3 years) operating plans, goals, and objections for the regulation of health plan form filings and implements tactics for the ongoing review of health plan form filings.
Directs and controls the development and implementation of policies, procedures, regulation, and statutes for the regulation of health plan forms.
Directly accountable for the overall performance of the Health Forms Program.
Directs the review of health plan forms submitted by regulated entities.
Assures appropriate and optimum use of the organizations resources and enhances the effectiveness of employees through timely appraisal and professional development opportunities.
Independently identifies undecided policy and legal issues, directs questions to the appropriate subject matter experts, and develops and implements tactics to address existing gaps, including rulemaking and legislative proposals.
Represents the OIC on a local and national level, speaking on behalf of the agency, and participating on National Association of Insurance Commissioner’s (NAIC) task forces and work groups.
Supervise the Health Forms Program Functional Program Analysts who perform the following in their review of health plan filings for all health plan issuers (regulated entities), including but not limited to:
Developing performance expectations and conducting performance evaluations, including individual development, and training plans.
Assigning, planning, instructing, and checking the work of assigned staff; coaching and recognizing staff.
Approving/disapproving request for outside employment, leave, and overtime and/or exchange time; recommending or approving/disapproving (as delegated) employee training requests.
Conducting supervisory fact-findings into alleged misconduct and/or performance deficiencies, taking appropriate corrective action, and/or disciplinary action up through a Letter of Reprimand. (For discipline affecting pay of individuals, make a recommendation for consideration to the appointing authority.)
Bachelor of Arts or Bachelor of Science degree.
Three (3) years’ experience in each of the following:
Analyzing health plan forms (contracts or policies).
Supervisory or lead experience of professional level staff.
Interpreting federal or state law and rules, and case law, in an insurance compliance position.
Preferred/Desired Qualifications of this position include:
Advanced degree in either business or law.
Two (2) years’ experience with the System for Electronic Rate and Form Filings (SERFF).
Currently possess or actively pursuing one or more insurance focused professional designations such as Certified Insurance Examiner (CIE), Healthcare Compliance Professional (HCP), Health Insurance Associate (HIA), Associate Insurance Regulatory Compliance (AIRC), Associate Professional in Insurance Regulation (APIR) or a similar designation program.
Annual Salary: Up to $105,816 Annually depending on experience
Sales & Distribution Manager
The Sales and Distribution Manager will report to the Commercial Auto Insurance Product Manager and be a key member of the product launch team with responsibility for marketing and sales through multiple channels (direct, agent and digital).
Annual Salary: https://corporate.ford.com/content/dam/corporate/us/en-us/documents/careers/2022-benefits-and-comp-LL6-sal-plan-1.pdf
Underwriting is considered the cornerstone of our future success in the commercial auto insurance market. The Underwriting Manager will report to the Commercial Auto Insurance Product Manager and be a key member of the product launch team with responsibility for oversight of the underwriting policy, processes, compliance and results. The Underwriting Manager will also participate in development of underwriting and pricing models.
Annual Salary: https://corporate.ford.com/content/dam/corporate/us/en-us/documents/careers/2022-benefits-and-comp-LL6-sal-plan-1.pdf
Annual Salary: https://corporate.ford.com/content/dam/corporate/us/en-us/documents/careers/2022-benefits-and-comp-LL5-sal-plan-1.pdf
Participates in the administration and oversight of compliance programs for all jurisdictions and product lines written by CopperPoint
Works with the CCO, VP Compliance, and Compliance Oversight Committee to assist CopperPoint departments to develop and implement compliance programs that include: identification of applicable regulatory requirements, creating control plans to ensure compliance, monitoring for changes to requirements, identifying areas of non-compliance and implementing and tracking actions to restore compliance
Assists in coordinating and administering licenses held by the CopperPoint group and in making required filings to maintain those licenses with state insurance departments, secretaries of state, corporation commissions, etc.
Coordinates and maintains a log of responses to regulatory matters and/or inquiries from regulators, Better Business Bureau.
Works with attorneys and Compliance Manager to research, document, communicate and track compliance-related legal and regulatory changes and information arising from bulletins and other information issued by regulatory and non-regulatory authorities (including PCI, NAMIC, NAIC, NCCI, ISO, and AAIS) affecting lines of business written by CopperPoint and follows up to ensure implementation of necessary changes
Assists in reviewing new and revised insurance products, policies, and other required forms to ensure compliance with state regulatory and statutory requirements and in making required filings
Assists in coordinating regulatory examinations and audits (i.e. financial exams, market conduct exams) and responses to data calls and surveys
Manages regulatory/compliance software as needed
Manages contract flow process from request receipt, scheduling contract reviews, managing drafts, verifying agreed-upon edits in drafts have been completed, and transmitting drafts
Track signatures on contracts and other legal documents under the supervision of the Contracts Team
Helps develop and maintain agreement templates and key term checklists used to review and revise contracts, and maintain contracts playbooks with current legal standards
Perform other compliance, legal and administrative tasks
Supports the Compliance Committee, ad-hoc and special projects
Helps to develop, implement and continually improve processes and procedures
Prepares reports and metrics for the compliance/contracts team, as needed
Bachelor’s Degree and a minimum of 1-year previous experience in corporate compliance, legal, risk management, or internal audit environment preferred. Corporate regulatory compliance and contract administration experience are a strong plus. Paralegal certification is a strong plus.
Research skills to perform legal and compliance research using electronic sources
Prior work in the insurance industry is a strong plus
Organizational skills to effectively and efficiently work with large volumes of documents and data
Ability to analyze complex compliance issues, evaluate alternatives, and recommend creative solutions
Effective presentation skills
Strong analytical skills with the ability to successfully manage and prioritize multiple tasks
Advanced skills in Adobe Acrobat and Microsoft Word, including redlining/tracking changes to contracts during negotiations.
Proficient with collaboration software including Teams and SharePoint.
Self-driven with a desire to independently expand knowledge on relevant legal, compliance, and business topics
Strong initiative and problem-solving skills
Research and analytical skills
Ability to maintain strict confidentiality of sensitive information
Strong work ethic with the ability to work independently
$62,000.00 – $82,000.00 annually
Compensation may vary dependent on skills, experience, education, and geographical location.
In addition to base salary, compensation may include an annual discretionary bonus.
Founded in 1925, CopperPoint Insurance Companies is a leading provider of workers’ compensation and commercial insurance solutions. With an expanded Line of insurance products and a growing ten-state footprint in the western United States, CopperPoint embodies stability for policyholders in Alaska, Arizona, California, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, and Washington. CopperPoint Mutual Insurance Holding Company is the corporate parent of Arizona-based CopperPoint Insurance Companies, Alaska National Insurance Company, and other CopperPoint Insurance Entities.
CopperPoint’s culture of compassion extends to the community through employee volunteerism, corporate matching, Board service, program sponsorships, and in-kind contributions. We empower employees by providing 12 hours of paid volunteer time annually and matching their personal contributions to the charities of their choice up to $500 per year. In 2020, CopperPoint employees reported 3,500 volunteer hours.
CopperPoint offers a competitive compensation package and comprehensive benefits package including major medical, dental, and vision and a wide range of competitive benefits programs, generous matching contributions to your 401(k) plan, generous paid time off, tuition reimbursement, and other education benefits and business casual dress. CopperPoint is an equal employment opportunity employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status, or any other characteristic protected by state, federal or local law. CopperPoint maintains a drug-free workplace.
Annual Salary: $62,000.00 – $82,000.00