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Medical Vendor Oversight Specialist - TCC

Company: Accident Fund Holdings, Inc
Location: Lansing
Posted on: February 15, 2020

Job Description:

**Lansing or New Berlin** SUMMARY: The Medical Vendor Oversight Specialist will provide day to day monitoring of vendor customer service partnership to ensure the effectiveness of the TeleCompCare (TCC) Program for Brand policyholders. This position will have a wide variety of specialized functions in support of the TCC program working with the TCC Manager and Brand Underwriters. Responsible for generating, maintaining, analyzing and reporting the results of TCC results and outcomes. Audits and monitors vendor performance and compliance with the contract. Responsible for performing administrative tasks which may be highly confidential and sensitive in nature utilizing considerable independent judgment. RESPONSIBILITIES/TASKS: Takes the lead on vendor issues following submitted complaints and provide resolutions to meet internal performance standards. Direct, communicate, assign and manage work referred to vendors. Assist in implementing of new vendor services, including communication and workflow/ processes. Develop and manage vendor relationships including scheduling of meetings, greeting and assisting vendors. Works closely with manager and brands on implementation of new policyholders in the TCC Program. Inform appropriate staff of issues as necessary. Analyzes trends and reviews reports as requested or scheduled (i.e. metrics, scorecards, compliance, cost center etc.). Prepares materials for presentation to all customers while maintaining confidentiality. Trains MMX team and internal customers on the use of the TCC program. Evaluate and monitor TCC vendor based on service needs of the brands and ensure customer service efforts are being met. Responsible for ensuring vendor compliance to corporate standards (i.e. timely submission, purchasing, timekeeping, licensing). Conducts annual vendor audits as scheduled or on an as needed basis. Make recommendations for metrics used to measure vendor performance. Respond to calls, email communication and provides information to vendors, insured, providers or routes calls to the appropriate staff. Establishes and maintain effective working relationships with all internal and external customers. Develop a strong relationship and partnership with the claims department. Assist in the development of team goals. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION: Bachelor's degree in insurance, business or a related field required. Relevant combination of education and experience may be considered in lieu of degree. College level medical courses required. Continuous learning, as defined by AFHI's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged. CAWC highly preferred. EXPERIENCE: A minimum of two years experience in an insurance organization or completion of trainee program with demonstrated skills in the areas of medical cost containment vendors, oversight of vendors, auditing and contract review. Workers compensation experience preferred. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Ability and proficiency in the use of computers and company standard software specific to position. Knowledge of workers' compensation laws and regulations, including jurisdictional laws. Effective customer service skills. Ability to negotiate, build consensus and resolve conflict. Ability to manage multiple priorities and meet established deadlines. Attention to detail and analytical skills. Ability to work independently as well as within a team. Ability to work effectively in a multi-functional business unit. Excellent oral and written communication skills. Ability to comprehend consequences of various situations and to make appropriate individuals aware of these to facilitate decision making. Excellent organizational skills and ability to prioritize work. Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format. Ability to effectively exchange information clearly and concisely, present ideas, report facts and respond to questions, as appropriate Ability to provide customer service by responding appropriately to inquiries or concerns from agents, policyholders, regulatory agencies, management, and employees. Effective presentation skills in a variety of settings. WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. Minimal travel required with occasional overnight stays. Work is required at various times of the day and sometimes weekend work may be required. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

Keywords: Accident Fund Holdings, Inc, Lansing , Medical Vendor Oversight Specialist - TCC, Healthcare , Lansing, Michigan

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